What documents should I organize for my family when I have advanced cancer?

Two kinds: the papers that say what you want done for you, and the papers that tell your family where everything is. Most people do the second and skip the first.

The National Cancer Institute frames this as putting your affairs in order, and says careful planning cuts the financial, legal, and emotional load your family carries later.

Start with the ones that only work if signed early

Advance directives are legal papers stating what medical care you want if you cannot speak for yourself. There are two main kinds.

A living will says which treatments you would or would not want. The topics it usually covers are machines that keep you alive, such as ventilators and dialysis, do-not-resuscitate orders that tell the team not to use CPR if your heart or breathing stops, tube feeding, withholding food and fluids, and organ and tissue donation.

A durable power of attorney for health care names a person to make medical decisions for you when you cannot. It goes by other names too: health care proxy, or medical power of attorney. The person named may be called your agent, surrogate, or proxy.

Two details make or break these documents. Most states require a witness at the signing, so review them with your doctor for accuracy before you sign. And each state writes its own laws, so a directive accepted in one state may not be accepted in another. State-specific forms can be downloaded from the National Hospice and Palliative Care Organization.

After signing, give copies to your doctor, the hospital, and family members, and store your own copies somewhere easy to reach. Consider carrying a card in your wallet saying you have a living will and durable power of attorney and where they can be found. You can change your mind at any time; when new directives are signed, destroy the old ones.

The list of accounts to write down

For each of these, write down who to contact and what needs to be done.

• Banks, savings, and loans
• Safety deposit box details
• Life insurance company
• Health insurance company
• Homeowners' or renters' insurance company
• Attorneys
• Accountant
• Pension or retirement plans
• Investment companies
• Credit card companies
• Employer

You may not need every line. Cross off what does not apply rather than leaving it blank and ambiguous.

Where to keep it all

Four rules from NCI cover most of the trouble families run into.

Make a list of where your family can find important papers, and tell them the list exists. Keep the papers themselves in a fireproof box or with a lawyer. If anything is in a safety deposit box, confirm that a family member or friend actually has access to that box, since the bank will not open it on sympathy alone. Give family members photocopies, and keep the originals safe, because legal steps require originals.

Your bank can answer questions about changing accounts and credit cards. A lawyer or financial planner can confirm you have not missed a step.

Two things to settle while you are at it

Call your health insurance company if you are considering a new treatment or hospice. Most plans cover hospice, and many cover brief home visits from a nurse or home health aide several times a week. Asking now prevents a payment fight later.

If it feels right, help plan the funeral or memorial service. Doing it in advance spares your family from making those choices while grieving. Some people want a celebration, others something quiet. Say which.

If the conversation is too hard to start, hold a family meeting and ask a social worker or a member of your faith community to guide it.

Sources

https://www.cancer.gov/about-cancer/advanced-cancer/planning

https://www.cancer.gov/about-cancer/managing-care/advance-directives