What do you understand about your current health or if you have any illnesses what have you been told by your healthcare providers? What do you expect to happen over time? (E.g. Do you expect to get better, be cured, or is your illness expected to get worse over time? Might you develop difficulty with memory, swallowing, walking or other things that are important to you?)


If you have illnesses and are unsure about what might happen over time, what information about the illness and treatments would be helpful to you? Is there information that you don’t want to know?

Things that Make Life Worth Living

What brings quality to your life? What is important and gives your life meaning? (E.g. being able to live independently, being able to recognize important people in your life, being able to communicate, being able to eat and taste food, spending time with friends and family etc.)

Worries & Fears

Think about the care you might need if you have a critical illness or if you are near the end of your life. What might you worry about or what fears come to mind? (E.g. struggling to breathe, being in pain, being alone, losing your dignity, depending entirely on others or being a burden to your family and friends, being given up on too soon etc.)


If you became critically ill, life support or life extending treatments might be offered. Describe for your SDM the state you would consider unacceptable to keep living in.

Near the End

If you were near the end of your life, what would be important to you? (E.g. family and friends nearby, dying at home, having spiritual rituals performed, listening to music etc.)