Before I Die Wall


National Healthcare Decisions Day (NHDD) takes place each year on April 16. The purpose is to inspire, educate and empower the public and providers about the importance of advance care planning. NHDD is an initiative to encourage patients to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be. The Putnam County Hospice and Palliative Care Association provides information and tools for the public to talk about their decisions for end of life care with family, friends and healthcare providers.

We celebrate NHDD for an entire week, April 15-21, 2019
We understand conversations about health care and end of life are difficult. These resources are good starting points for your conversation:
  • The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care. They offer a Starter Kit that guides important questions about your health care decisions.
  • Not up for conversation? The non-profit group, Coda Alliance offers a card game, Go Wish,  to facilitate conversations around what is most important for you.
  • has a large list of advanced care planning resources from a variety of providers
  • Honoring Choices Indiana is advancing conversations throughout the state of Indiana

Advance Care Planning

Advance care planning is making decisions about the healthcare you would want to receive if you happen to become unable to speak for yourself. These are your decisions to make, regardless of what you choose for your care, and the decisions are based on your personal values, preferences, and discussions with your loved ones.

Advance care planning includes:

  • Getting information on the types of life-sustaining treatments that are available.
  • Deciding what types of treatment you would or would not want should you be diagnosed with a life-limiting illness.
  • Sharing your personal values with your loved ones.
  • Completing advance directives to put into writing what types of treatment you would or would not want – and who you chose to speak for you – should you be unable to speak for yourself.

Indiana Advance Directive Form


Here are some important things to know about Advance Directives:

  • Your advance directive should reflect your wishes
  • Lawyers are not needed
  • Not all documents are legally valid in every state
  • A witness and a notary may be required
  • Does not expire and can be updated as needed

Choosing your Healthcare Representative

A healthcare agent (surrogate or proxy) is someone you designate to make medical decisions for you if, at some future time, you are unable to make decisions yourself. Your agent can be a close relative or friend, but should be someone who knows you well and someone you trust. In most states, your agent can make decisions any time you lose the ability to make a medical decision, not just decisions about the end of life.

This person should be someone who

  • Knows you well
  • Is calm in a crisis
  • Understands how you would make the decision if you were able
  • Is not afraid to ask questions and advocate to doctors
  • Can reassure and communicate with your family

Specific forms for designating your healthcare agent are on the Indiana State Department of Health website:

(PDF | Word) Health Care Representative Appointment

Be sure to also read through the Health Care Representative Appointment Information available on the same website.

Other Useful Forms

(PDF | Word) Life Prolonging Procedures Declaration

(PDF | Word) Living Will Declaration

(PDF) Out-of-hospital Do Not Resuscitate Declaration and Order

(PDF | Word) Physicians Order for Scope of Treatment (POST)