Public Journey
You don't have to figure out what this means all at once. This path covers the most important practical steps, including options most people don't know they have until they need them: palliative care (not the same as hospice), advance directives, Oregon's Death With Dignity Act, and legal protections for trans and queer people at end of life.
Step 1
Ask your doctor directly: What is this illness? What's the expected course? What are the treatment tradeoffs? You can also request a second opinion, that's not giving up, it's making an informed decision.
Write down questions before appointments. Bring someone to take notes. You are entitled to complete information about your condition and all available options.
Step 2
Palliative care is specialized support focused on managing symptoms and improving quality of life. You can receive palliative care while still receiving curative treatment: they're not mutually exclusive.
Ask your doctor for a referral, or contact a program directly:
You don't have to be near the end to access palliative care.
Resources
Step 3
This is the most important legal protection you have. An advance directive names the person who makes medical decisions if you can't, and records what you do and don't want in specific situations.
Oregon has free forms. You do not need a lawyer. Download them at oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EMSTRAUMASYSTEMS/Documents/AdvanceDirective-2019.pdf or ask your provider.
🏳️⚧️ Trans-specific: Name your chosen person explicitly, even if they're not a legal next of kin. Oregon law recognizes your advance directive over biological family default. Without this document, biological family may override your wishes.
Step 4
A POLST (Portable Orders for Life-Sustaining Treatment) turns your wishes into medical orders that travel with you, EMS can act on them, unlike an advance directive which is a planning document.
You need both documents: an advance directive for planning, and a POLST for actionable orders.
Learn more and download the form at oregonpolst.org. Your doctor signs the POLST with you.
Step 5
Hospice becomes available when a physician certifies a prognosis of six months or less. It's a shift from curative treatment to comfort care.
Everything is covered under Medicare Part A and OHP: nursing, medications related to the terminal illness, equipment, chaplain, social work, and bereavement care for your people. You choose your hospice, your insurance cannot restrict that choice.
You can ask about hospice before you're "ready", understanding your options isn't committing to anything.
Resources
Step 6
Oregon was the first state in the country to legalize medical aid in dying. If you're 18+, an Oregon resident, and have a terminal prognosis of six months or less from two physicians, you can request a prescription for medication you can self-administer.
End of Life Choices Oregon (503-922-1132) provides free volunteer support through the entire process, from understanding eligibility to finding a willing prescriber.
This option is entirely your choice. Exercising it or not exercising it doesn't affect your access to any other care.
Resources
Step 7
End-of-life care presents specific risks for trans people: providers may misgender you, biological family may override your wishes, and funeral homes may not honor your identity. Completing the right legal documents now protects you.
In addition to an advance directive, complete the "Appointment of Person to Make Decisions Concerning Disposition of My Remains": this Oregon-specific form gives your chosen person legal authority over your body after death, bypassing the default next-of-kin chain. No notary required. The Oregon Funeral Directors Association explains it at oregonfuneral.org.
Friendly House Elder Pride Services (503-224-2640) provides end-of-life planning support specifically for LGBTQ+ people in Multnomah and Washington counties.
The Commons Law Center (503-850-0811) offers sliding-scale estate planning and wills in Portland, having a will means Oregon's intestate succession laws don't default to legal next of kin.
Resources