Advance Care Planning

No one expects a sudden medical emergency, but planning for one is one of the most comforting actions you can take for yourself and your family. Advance Care Planning (ACP) is the ongoing process of reflecting on, discussing, and legally documenting your wishes for future medical care if you experience a serious health problem and become unable to communicate or make decisions for yourself. It is not exclusively for the elderly or chronically ill—it is an essential element of proactive health management for every adult.

Understanding Your Options & Tools

Advance Directives are instructions you give regarding your future care. To ensure that everyone understands your instructions, the State of New Hampshire recognizes a written Advance Directive as a legal document with two parts:

  • Durable Power of Attorney for Healthcare (DPOAH)
    • A document in which you name another person to act as your health care agent to make medical decisions for you if you lack the capacity to make health care decisions and guidance on the decisions your agent can make.
  • Living Will
    • A guide to your agent and health care team to help make decisions (if you cannot) about when you would want or not want life sustaining medical treatment to try to prolong your life

Critical Distinction: Advance Directives vs. Do Not Resuscitate (DNR) Orders

An advance directive is not a Do Not Resuscitate (DNR) order.

  • Advance directives are a guide to your end of life wishes.
  • A DNR is a medical order which dictates that if your heart stops beating, medical staff will make no attempts at cardiopulmonary resuscitation (CPR), chest compressions, defibrillator shocks, or mechanical breathing tubes.
    • If you want these instructions followed outside of a hospital setting, speak to your provider about an portable DNR.

How to Complete Your Advance Directive

We strongly advise completing your advance directive well ahead of a medical crisis so that you have ample time to deliberate on your options without emotional pressure.

  1. Obtain the Correct State Forms
    • Download the comprehensive Advance Care Planning Guide from the Foundation for Healthy Communities.
    • Ask your doctor's office
    • See an attorney who specializes in advanced care planning
  2. Engage in Meaningful Conversations
    • Discuss your core values, beliefs, and treatment goals with your family, loved ones, and medical professionals.
    • Ensure your designated healthcare agent completely understands your perspective and is prepared to voice your choices.
  3. Execute the Document Legally
    1. Fill out the sections that fit your personal desires.
    2. Sign in the presence of two authorized witnesses or a notary public
  4. Distribute Copies to Your Care Team
    • Your doctors and healthcare facilities will not automatically know if an advance directive exists. You are responsible for distributing clear copies to your primary care provider, your hospital, your family, and your healthcare agent.

How to Submit Your Documents to Us

Once provided, your document will be scanned directly into your secure electronic chart. Please use one of the following official submission methods:

  • By fax: 603-536-2017
  • In person or By mail:

    Speare Memorial Hospital
    ATTN: Health Information Management
    16 Hospital Rd,
    Plymouth NH 03264

Frequently Asked Questions

  • Can I still make my own health care decisions?
    • Advance Directives only become active if your medical provider certifies that you cannot understand your medical condition and choices for care, meaning you do not have the capacity to make your own medical decisions. This becomes active when the doctor writes an order and notifies your health care decision maker.
  • What happens if I experience an emergency without an advance directive
    • New Hampshire law grants your next of kin authority as a surrogate health care decision maker if you become incapacitated. However, without written documentation, this may not be the person you would choose to make decisions, they may not know what your wishes are, they may be under extreme stress, and this law limits their authority to 180 days. Having an advance directive in place eliminates these burdens.
  • Can I alter or revoke my advance directive in the future?
    • Yes. You retain the right to modify or completely cancel your advance directive at any moment. To do so, completely destroy all existing physical copies and complete an entirely new form. You must distribute the updated copies to your healthcare providers and healthcare agent to ensure the outdated version is permanently replaced in your electronic medical chart.

Advance Care Planning Resources

Here are some free resources available to assist you in navigating these conversations:

  • NH Foundation for Healthy Communities
    • Statewide public health initiative. Offers the downloadable New Hampshire Advance Care Planning Guide containing all necessary legal documents.
    • Web: healthcommunities.org
  • The conversation project
  • Prepare for Your Care
    • An interactive, self-guided online tool that walks users through state-specific care choices and helps construct an advance directive independently.
    • Web: prepareforyourcare.org
  • Need more guidance?
    • Outpatients: Please contact your primary care provider's office to initiate planning.
    • Inpatients: Ask for a Patient Care Manager, directly from your room.
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