• No single word responses (at least 70+ words in each response)
  • Give the questions some thought and answer honestly


  1. What will be important to you when you are dying? (2 points)


  1. How do you feel about the use of life sustaining measures in the face of terminal illness? Permanent coma? Irreversible chronic illness, such as Alzheimer’s disease? (2 points)


  1. Do you have strong feelings about particular medical procedures? Some procedures to think about include: mechanical breathing (respirator), cardiopulmonary resuscitation (CPR), artificial nutrition and hydration, hospital intensive care, pain relief medication, chemo or radiation therapy and surgery. (2 points)


  1. What limitations to your physical and mental health would affect the health care decisions you would make? (2 points)


  1. Would you want to be placed in a nursing home if your condition warranted? (2 points)


  1. Would you want to have financial matters taken into account when treatment decisions you would make? (2 points)


  1. Would you prefer hospice care with the goal of keeping you comfortable in your home during the final period of your life, as an alternative to hospitalization? (2 points)


  1. In general, do you wish to participate or share in making decisions about your health care and treatment? (2 points)


  1. Would you always want to know the truth about your condition, treatment options and the chance of success of treatments? (2 points)