Making Life Decisions booklet

Advanced Care Planning: Making Life Decisions: To help you make informed advanced care planning decisions, the team at Kokua Mau has developed this wonderful resource for your use. You may view the booklet here. Download PDF

Planning Ahead

Advance Directives

penpaperAn Advance Directive is a set of instructions, usually written, that allows you to specify the kind of treatment you would want if you are ill and unable to speak for yourself. The Living Will and the Durable Healthcare Power of Attorney are advance directives and we suggest you have both. With an advance directive, you can inform your doctor what your wishes are. You may change your advance directives at any time. Only you can change your advance directive. Each state has its own laws about advance directives and you should be aware of the laws in your state. Generally you can prepare advance directives in several ways:

Durable Healthcare Power of Attorney

A Durable Healthcare Power of Attorney is an advance directive that allows you to name an agent to speak for you in medical matters if you cannot speak for yourself either because of illness or an accident. Your agent should know your wishes and agree to follow them.

Living Will

A Living Will is an advance directive that states your wishes for medical treatment, including artificial nutrition and hydration, when you are in imminent danger of dying.

Five Wishes – a form of a Living Will

hospice-0033-3195523671-O (800x532)Five Wishes is the first form of a living will that takes into consideration your personal, emotional and spiritual needs. It is an easy-to-complete form that lets you say exactly what you want. Once it is filled out and properly signed it is valid under the laws of most states. There are many things in life that are out of our hands. The five wishes document gives you a way to control something very important – how you are treated when you are seriously ill. For a link to the Five Wishes document see the bottom of this page.

Five Wishes link:

Community Resources for Older Adults

You will find links below to the Aging and Disability Resource Center, a one-stop source for information, assistance, and access to community resources and services for older adults, people with disabilities and family caregivers. The Aging and Disability Resource Center serves as a virtual Aging and Disability Resource Center that, combined with traditional face-to-face services, provides greater options for accessing information, assistance, and referral for families living either near and far.

For more information you may also contact the Maui County Office on Aging Main
Telephone: (808) 270-7774
Located at 2200 Main Street, Suite 547, Wailuku, HI 96793 or

POLST (Physician’s Orders for Life-Sustaining Treatment)

hospice-0036-3195524025-O (800x532)POLST (Physician’s Orders for Life-Sustaining Treatment) is a physician’s order that gives patients more control over their end-of-life care. It specifies the types of treatments that a patient wishes to receive towards the end of life. Completing a POLST form encourages communication between healthcare providers and patients, enabling patients to make more informed decisions. The POLST form documents those decisions in a clear manner and can be quickly understood by all providers, including first responders and emergency medical services (EMS) personnel. As a result, the patient’s wishes can be honored across all settings of care. The POLST form is usually completed on a distinctive bright lime-green form, but is also freely available from the internet and is acceptable in black and white. The bright color is to make the form quickly visible to families and emergency medical services personnel. The lime-green color is also easily copied. A copy is a valid document.

POLST does not replace an Advance Health Care Directive (AD). The AD can provide a significant amount of more detail about an individual’s wishes and preferences for treatment. In addition, the AD is the most common mechanism for designating a surrogate decision maker for the patient. The POLST does not provide for the designation of a surrogate decision maker.

For the patient at home, the POLST form should be kept in a place readily accessible by family members. Examples include on the refrigerator, in the medicine cabinet, on the back of a bedroom door or on a bedside table.


  1. The consumer info for POLST
  2. Hawaii POLST form here

For more information on bereavement support for children, teens and their families click