The ICU nurse stepped into the hallway, keeping her voice low. She had asked the question she always dreads asking. “Does your mother have a living will?”
The daughter shook her head. Her mother, 71 years old and unable to speak after a stroke, lay in a hospital bed with a ventilator breathing for her. The family had never talked about this. There was no document, no recorded wish, no named person with legal authority to decide. So the decision fell to a family divided — one sibling saying “do everything,” another saying “she never wanted this” — and there was no way to know which was right.
This happens every day in American hospitals. And it does not have to.
Most Americans Are Not Ready
What a Living Will Actually Does
A living will is not a single form with a few checkboxes. Done right, it is a detailed written document that speaks for you when you cannot speak for yourself. It tells your doctors, nurses, and medical power of attorney exactly what you want — and what you do not want — if you are ever too ill or injured to make or communicate your own decisions.
Think of it this way: a checkbox labeled “no CPR” cannot explain why you made that choice, under what conditions you might feel differently, or what “comfort care” actually means to you personally. A thorough living will puts all of that into words. It leaves your care team with something real to follow.
A comprehensive advance care plan goes further. It includes the living will, a medical power of attorney naming someone to make healthcare decisions on your behalf, and a durable power of attorney for financial matters — so that if you are incapacitated, the bills get paid, and the bank account can be accessed. The people who love you are not left scrambling through paperwork while they are also trying to grieve.
The Numbers Are Alarming
Here is where the reality stings.
A 2025 survey found that only 5% of Americans have a complete advance care plan in place, while half of all adults are unfamiliar with the concept of advance care planning. A separate national study found that roughly one in three U.S. adults has completed an advance directive — but “completing” often means a basic checkbox document rather than a thorough, values-based plan.
In Kentucky, the numbers are even more sobering. Only 9% of Kentucky adults have completed a living will, and approximately the same percentage have designated a healthcare surrogate.
More than 80% of older adults say they understand that end-of-life planning is important, yet only 33% have a living will. The gap between knowing and doing is enormous — and for thousands of families each year, that gap becomes a crisis at the worst possible moment.
Why People Are Turning to AI
Fast, Free, and a Few Clicks Away
No judgment here. Life is expensive. Time is scarce. When a family caregiver is managing doctors’ appointments, insurance paperwork, and the emotional weight of watching a parent decline, the idea of typing a few questions into an AI chatbot and printing out a finished document sounds like genuine relief.
AI tools have helped people learn about end-of-life care options, understand hospice benefits, and locate community resources they would not have found on their own. Practical, logistical information — AI can handle a lot of that. That usefulness is real and worth acknowledging.
The Real Cost of a Shortcut
There is a meaningful difference between learning about something and legally documenting what you want done to your body when your heart is failing.
Picture this: a 58-year-old woman types her wishes into an AI tool late one night after a cancer diagnosis. The document it generates looks professional. She prints it, signs it, and puts it in a folder. Three years later, she is in the hospital and cannot speak. Her husband hands the document to the attending physician. The doctor reads it, pauses, then says quietly, “I’m not sure what she means here. Some of this language doesn’t align with what we can legally honor in this state.”
The document she trusted with her life was incomplete. Inconsistent. Not legally valid where she lived.
That is the real cost.
What AI Gets Wrong
Hallucinations Are Real — and Dangerous
AI engines do something that sounds almost impossible: they make things up. Confidently. Fluently.
The technical term is “hallucination,” and it means that an AI system can generate information that is factually wrong, medically outdated, or legally invalid — and present it with the same calm, authoritative tone it uses when it is actually correct. One technology analyst described it plainly: “An algorithm is only as reliable as the data it feeds on. If the underlying data is scattered or inconsistent, AI will simply automate confusion and amplify errors.”
The problem is compounded by the lack of regulatory oversight for end-of-life planning documents. There is no governing body checking whether the living will your AI tool generated is legally valid in your state. There is no physician reviewing the medical terminology. The document might look like a living will. It might read like one. And it might still fail the people you love when they need it most. AI hallucinations in an end-of-life context are not a minor inconvenience. They are a patient safety issue.
Values Cannot Be Typed Into a Prompt
Here is what no AI can do.
A certified advance care planning specialist sits across from a 67-year-old man who has just said he wants “everything done” if he becomes critically ill. She does not move on to the next question. She pauses and asks, “When you say ‘everything,’ what does that look like in your mind?”
He thinks for a moment. “I want to be alive. I want to be there — for my grandkids, for my wife.”
She leans forward. “If you were alive but couldn’t recognize them — couldn’t interact — would that still feel like being there to you?”
His face changes.
That conversation — that single moment — is where a real advance care plan is built. Not in the answer he originally typed, but in what the follow-up question revealed about what he actually values. AI cannot do this. It cannot watch his face. It cannot hear the catch in his voice. Hospice medical directors have said plainly that AI “is not sophisticated enough to have cultural humility or show more empathy than a person” — and that limitation matters enormously in planning this personal.
Who Should Write Your Plan
Why Attorneys and Doctors Are Not Enough
Attorneys are skilled at translating intentions into legal language. They are not trained to explain to a body what a ventilator actually does, or what “comfort measures only” looks like in a medical setting at three in the morning. Physicians are trained to diagnose and treat, not to sit with a patient for an hour and a half, exploring the values and fears that shape what that patient truly wants. Both are essential professionals. Neither is designed for this specific, time-intensive work.
Advance care planning specialists exist precisely because this work requires a different kind of expertise: the ability to explain complex medical realities in plain language, to ask the questions that draw out genuine values, and to translate those values into clear, actionable written instructions that a nurse or physician can actually follow at the bedside.
What an Advance Care Planning Specialist Does
The specialist does not walk in with a clipboard and a checklist.
He pulls his chair close. He asks: “What scares you most about losing the ability to make your own decisions?” He asks: “What has serious illness looked like for people you have loved — and what did you take from that experience?” He asks: “If you could no longer do the things that make your daily life feel meaningful, what would you want us to do?”
Each answer opens another question. Each question builds a clearer picture of who this person is and what a good death — or a dignified life in the face of serious illness — looks like to them, specifically. The resulting living will is not a checkbox form. It contains detailed written instructions that reflect the individual’s values, beliefs, medical understanding, and personal priorities, and coordinates them across the living will, the medical power of attorney, and the durable power of attorney for financial matters into one coherent plan.
That is not something a prompt can produce.
Your Next Step Starts Today
You might be 28 years old and perfectly healthy. This still matters to you. Accidents do not check ages. Sudden illness does not send a calendar invite.
Planning ahead is not an act of giving up. It is one of the most generous things you can do for the people who love you. Picture the nurse at the bedside, the doctor at the chart, your daughter in the waiting room — all of them knowing exactly what you want, exactly who has the authority to speak for you, and exactly what kind of care reflects who you truly are. That clarity is a gift.
Contact an advance care planning specialist. Ask your hospice organization, palliative care team, local Area Agency on Aging, or hospital social worker for a referral. This does not require a crisis to begin. It only requires one step.
Free Daily Symptom Tracker: Each headache, flare, or fatigue spike reveals a clue. This two-page Daily Symptom Tracker records sleep quality, food intake, triggers, severity, and effective relief methods—all in one place. Use it daily for 31 days and share the pages with your healthcare provider or health navigation expert. Together, you can move from guessing to addressing the root cause. Instructions on how to use the free daily symptom tracker and the free daily symptom tracker.
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Compassion Crossing Academy — Free and paid online courses are available to teach caregivers, nurses, social workers, chaplains, end-of-life advocates, and educators, including death doulas, how to confidently coordinate complex care.
The Death Deck is often a wonderful conversation starter.
Compassion Crossing, LLC, via Peter M. Abraham, BSN, RN, EOLD, offers on-site services in Madison County, KY, as well as in the seven nearby counties—Clark, Estill, Fayette, Garrard, Jackson, Jessamine, and Rockcastle—and provides virtual options when no local provider is available.
Hospice Buddy: Although Jamie Haberman, RN, CHPN, isn’t a certified end-of-life doula, her virtual services are highly valuable.
Currently, no official organization regulates end-of-life doulas (EOLDs). Remember that some EOLDs listed in directories may no longer be practicing, so it’s important to verify their current status.
End-of-Life Doula Schools
Before you consider a death doula school, please volunteer with a local hospice provider as a “companion volunteer” to gain experience with strangers who are dying, as well as with family and staff dynamics. The author also recommends reading the article Economic rant: The death doula crisis we aren’t talking enough about, as most death doula schools do not emphasize that being a death doula is a calling rather than a career.
The following are end-of-life (aka death doula) schools for those interested in becoming an end-of-life doula:
Compassion Crossing Academy: Although it isn’t a dedicated death-doula school, it offers unique classes that can help death doulas expand their practice. It serves as an important resource for individuals looking to deepen their understanding and grow in this meaningful profession.
Remember that there is no official accrediting body for end-of-life doula programs. Certification simply shows you’ve completed an unaccredited course and received a certificate of completion. It’s advisable to have discovery sessions with any death doula school you’re considering — even if it isn’t listed here — to see if it meets your needs. Also, ask questions and reach out to references, such as former students, to assess whether the school provided a solid foundation for launching your own death doula practice.
