Nearly all of us have a story: The grandfather who died peacefully in his sleep, the mother who spent her last days struggling in the hospital, the friend whose final hours were filled with meaning through the support of hospice.

End-of-life care is receiving ever more attention in the world of health care because of a growing recognition: We can provide better care with more satisfied patients, better informed families, doctors who are more confident of patient wishes, all with the same life expectancy through authentic conversations. Honoring Choices Wisconsin, an initiative of the Wisconsin Medical Society, is aiming to make these reflective conversations a routine part of care.

It begins with advance care planning, the process of understanding, reflecting on and discussing future medical decisions, including end-of-life preferences. More than just a document, advance care planning includes understanding health care treatment options, clarifying health care goals, appointing a health care agent to speak for you if you can’t speak for yourself, weighing options about the care you might want or not want, completing an advance directive, and communicating your wishes to those close to you, including your agent.

A Different and More Comprehensive Approach

Honoring Choices Wisconsin is a different and more comprehensive approach than the old reliance on documentation alone. Through the Respecting Choices® First Steps® program based in La Crosse, we’re training nurses, chaplains, social workers and other health care staff to facilitate advance care planning conversations with patients as a routine part of care. We’re also working to ensure
that those conversations are consistently conducted, documented, and entered into the medical record.

Many factors can affect a person’s wishes. Past experiences with crises or the death of a loved one shape how each individual prepares for his or her own care. Language, cultural norms and trust in the medical system play a role too. And religion and spirituality are critical for many as they explore the impact of certain treatment. Each of these concerns and more are part of any healthy advance care planning conversation, and we are working with clergy and community leaders to ensure that advance care planning is considered in that context.

I’ve told my agent (my wife) that as a younger person with a 2-year old son, I’m willing to fight pretty hard to live through a medical emergency. If I can spend just a few minutes a day watching my son play and grow up, it’s worth a lot of suffering. I’m also willing to be kept alive artificially if it provides a little extra time for my family to visit from out of state. Other people, such as my 80-year old grandmother, certainly have different priorities and preferences for themselves. I’ve shared these thoughts and others so my loved ones don’t have to guess, and my advance directive is on file with my home health system.

Shared Decision Making at its Best

Six organizations across South Central and Southeast Wisconsin are now offering facilitated advance care planning conversations as part of care, and an additional nine organizations have begun
training to offer the service beginning early next year. As Honoring Choices Wisconsin grows and expands, we aim to change the culture around advance care planning, so that everyone feels
comfortable having the conversation. Advance care planning is shared decision making at its best, and it helps give every one of us peace of mind.

For more information about Honoring Choices Wisconsin and how your organization can participate, contact John Maycroft at

John Maycroft is Director of Policy Development and Initiatives at the Wisconsin Medical Society and Program Lead for Honoring Choices Wisconsin.

John Maycroft

John Maycroft

Guest Blogger, Director of Policy Development & Initiatives at Wisconsin Medical Society
John Maycroft is Director of Policy Development and Initiatives at the Wisconsin Medical Society and Program Lead for Honoring Choices Wisconsin.
John Maycroft