Documenting

what you want

Ready to create a personal statement for your spokesperson, loved ones, and health care team?

Even if you have completed legal documents, such as a living will and health care proxy form, family members can still feel uncomfortable or unsure about how to make correct decisions on your behalf. When facing such difficult decisions, Andy Baxter (Cunniff-Dixon Foundation Founder) took solace in reading the letter that his wife Carley Cunniff left for him. A letter (or audio/video) written in your own words can sometimes be the most important document — giving your loved ones and health care practitioners reassurance that they are doing the right thing, within the framework and guidelines you’ve written about.

Sample Personal Statement

Review the example below and its primary sections to help you write your own.

Introduction/address your letter.

To My Health Care Proxy, Andy or Marian B.S. Young, and to my wonderful family.

Give your loved ones and health care providers “permission“ to follow your wishes.

With complete foreknowledge of the consequences of my doing so, I hereby fully relieve and release and without hesitation or qualification firmly direct and require my Executor(s) to relieve and release each of my personal physicians and each other Health Care professional, para-professional, administrator, etc. (without limitation) from any and all responsibility and/or liability, blame or accountability for following my wishes as interpreted and expressed by my health care proxy or agent, even if doing so appears to hasten the moment of my death and/or represent a failure to follow the Hippocratic Oath. I implore you, medical professionals, to hear, heed and honor my wishes.

Attach the letter to your formal advance directive and Planning My Way guide sheets.

I am writing this to augment the instructions on the attached formal Health Care Proxy.

Say what your wishes are in your own words and why.

I have been very fortunate in my life to be blessed, until recently, with excellent health and a strong physical constitution. As a result, I have enjoyed substantial independence of thought and action for most of my adult years. I abhor the idea of becoming a long-term drain and physical and/or psychological burden to my wonderful family and friends, despite my confidence that this is a burden they would likely accept willingly or at least stoically. It is not the way I would choose to finish out my life, and it is not the way I would choose to be remembered. The idea of total helplessness and dependence depresses me as I think about it today, still having fairly good health and personal control despite my cancer diagnosis. I love life, but it is life as I have known it, with substantial independence of thought and action, with the capacity for joy. The nature of my cancer has been such that I have already had several years to contemplate the idea of “untimely” death. There are worse things! A graceless, protracted, and burdensome demise is one of them. Thank you for assuming and executing this responsibility on my behalf.

Thank them for doing this difficult task and encourage them to follow your wishes.

To my wonderful siblings: While I love and trust all of you, I wish to spare each and all of you the responsibility which my appointing one or more of you would or might subject you to, and I fervently insist that each of you support the directives which Marian issues as my health care proxy.

Thank you so much

Want to see another example?

Take a look at this statement expressing a different set of wishes but using the same format

VIEW SAMPLE LETTER
Introduction/address your letter.

To my loving wife Joan, my family, friends, doctors and others who are helping me through these difficult times.

I need your help in ensuring that the very best for me is done. I want to live and I want treatments that might extend my life even with lesser quality. I want your help to do so. As such, I relieve my doctors and health care professional of responsibility and/or liability, blame, or accountability for following my wishes as interpreted and expressed by my health care spokesperson (often referred to as health care agent or proxy), even if doing so appears to cause me pain, or suffering, or hastens the moment of my death. I implore you, medical professionals, to honor my wishes.

Introduction/address your letter.

To my loving wife Joan, my family, friends, doctors and others who are helping me through these difficult times.

Give your loved ones and health care providers “permission“ to follow your wishes.

I need your help in ensuring that the very best for me is done. I want to live and I want treatments that might extend my life even with lesser quality. I want your help to do so. As such, I relieve my doctors and health care professional of responsibility and/or liability, blame, or accountability for following my wishes as interpreted and expressed by my health care spokesperson (often referred to as health care agent or proxy), even if doing so appears to cause me pain, or suffering, or hastens the moment of my death. I implore you, medical professionals, to honor my wishes.

Attach the letter to your formal advance directive and Planning My Way guide sheets.

I am writing this document to accompany the guidance provided by the advance directive documents.

Say what your wishes are in your own words and why.

Just months ago, I was living the best that life could offer. My beautiful wife Joan was by my side and Timmy had just turned three. But that changed in a moment when I had a grand mal seizure and was taken to the hospital. The doctors ran tests, including a CT scan, but couldn't find anything wrong. As they were preparing to send me home, Joan demanded an MRI. That's when the found the cancer—grade 4 glioblastoma multiforme. The neurosurgeons told me it is inoperable and that I have only a few months to live. I am a U.S. Army veteran of Iraq. I've been through a lot in my life and I've always resolved to never give up. There was a moment after my diagnosis when I considered assisted suicide as an option. But with my family's support, I know that is not the right option for me. I want to fight for every moment of life and I want you to do the same for me, even if I am unable to speak for myself

Thank them for doing this difficult task and encourage them to follow your wishes.

I know that this will be difficult. I know that Joan will fight for me, if and when I can’t. I hope that you, my family, will help her in that fight. No matter what happens, I trust that you will do the best that you can

Thank you for everything

A personal statement should do the following

  • Give your loved ones permission to follow your wishes and release them from any blame or negative consequences.
  • State what you would have wanted for your health care in your own words and why.
  • Assure them that you trust that their decisions will be made in good faith and with their best effort to do what you would have wanted.
  • Thank them for doing this difficult but important task.

Check to see if you are ready to write your statement.

Review the various points below and see if you are ready

  • Selected a spokesperson
  • Thought about your wishes
  • Thought about treatments
  • Ready to have conversations with your family and friends
  • Spoke with your care practitioner
  • Who to contact
  • What you value
  • What you want to happen after your death

Ready to create your statement?

START A PERSONAL STATEMENT

Have you completed a personal statement? If so, you are now ready to complete your advance directive.

While an advance directive and personal letter are very similar in there information and purpose there are two big differences. The personal letter is for lack of a better term more personal, while the advance directive is a legally binding document.