Advance Care Planning Home

The most precious gift we can offer is our presence.
When mindfulness embraces those we love, they will bloom like flowers.
Thich Nhat Hanh

We often take for granted that when difficult decisions will have to be made regarding our future healthcare, we will be able to make those decisions ourselves. “No one wants to think of illness, disability or death until that time comes.” “No use worrying ourselves or our loved ones with such talk.” “Besides, I’m young and I’m not sick; I have time to wait to think about those things or to make these decisions.” Do any of these thoughts sound familiar? You are not alone.

Each year thousands of us are faced with making medical decisions for ourselves or for our loved ones. A common statement from those having to make such decisions is, “I wish I would have talked to ‘my loved one’ about this, so I would have known what she wanted.” As for ourselves, we may avoid uncomfortable discussions regarding our own wishes in an attempt to protect and care for those we love. Talking with someone about our wishes is in fact a loving thing to do.

Durable Power of Attorney

Click on the links below to download, print or view.

English - Durable Power of Attorney

Russian - Durable Power of Attorney

Spanish - Durable Power of Attorney

Practical Guide For Advance Care Planning

Click on the links below to download, print or view.

English - Practical Guide For Advance Care Planning

Russian - Practical Guide For Advance Care Planning

Spanish - Practical Guide For Advance Care Planning

Living Will (Declaration to Physicians)

If the Durable Power of Attorney for Healthcare is not the preferred document for you, we do offer a link below to the Wisconsin State Living Will (Declaration to Physicians). This document will allow you to state preference regarding life-sustaining treatment in the event you are diagnosed with a terminal condition or are in a persistent vegetative state.

Please note: this form does not allow you to legally designate a person to make healthcare decisions for you if you are not able. Click on the link below to download, print or view.

English - Living Will (Declaration to Physicians)

If you do not have the Adobe Acrobat Reader Software you can download it here for free.

Columbia St. Mary’s offers a guide designed to assist you in beginning to discuss your choices. We are ready to help you begin this journey, but you must take the first step. Take some time to review this guide and start conversations with those around you. When you are ready to put those wishes in writing, click on one of the links above for the Columbia St. Mary’s Durable Power of Attorney for Healthcare form and Practical Guide for Advance Care Planning Guide available in English, Russian or Spanish versions. These forms will be a written declaration of your choices. Completing the Advance Care Planning process will provide you and your loved ones with peace of mind that your choices have been communicated, and your wishes are known.

Community Do-Not-Resuscitate Bracelets

A valid Community Do-Not-Resuscitate Bracelet instructs emergency medical technicians, first responders, and emergency health care facilities personnel to not attempt resuscitation but to only provide comfort care to a person for whom the order is issued, if that person suffers cardiac or respiratory arrest.

Wisconsin residents have a choice between a plastic and a metal bracelet to identify themselves as having a do-not-resuscitate order.

For more information on Community Do-Not-Resuscitate Bracelets in the state of Wisconsin, see the State Bar of Wisconsin Website at: http://www.wisbar.org/AM/Template.cfm?Section=LifePlanning&Template=/CM/ContentDisplay.cfm&ContentID=38083

Additional Information

We also recognize that it may be difficult to know what to discuss with your healthcare agent or whom to choose as a healthcare agent. Columbia St. Mary’s offers a set of questions that may be helpful for you:

English - Questionnaire For You As A Patient

Russian - Questionnaire For You As A Patient

Spanish - Questionnaire For You As A Patient


and your agent:

English - Questionnaire For Someone You Feel Could Make Decisions For You Were You Not Able To Make Decisions.

Russian - Questionnaire For Someone You Feel Could Make Decisions For You Were You Not Able To Make Decisions.

Spanish - Questionnaire For Someone You Feel Could Make Decisions For You Were You Not Able To Make Decisions.

We hope that when you compare your answers to those of your agent, you will have a better idea of topics to discuss to aid in your decision-making. We also have a compiled a list of other sites and resources for you to explore.

Columbia St. Mary’s offers sessions with a Healthcare Ethicist and trained social workers and chaplains who can help you create your own advance directive. To register for one of these free sessions (lunch included), click here to visit our Community Education webpage and type in or copy and paste “Advance Health Care Directive” into the title field.

Wishing you abundant health and happiness,
The Staff of Columbia St. Mary's