UNM HSC Institute for Ethics
1 University of New Mexico
Albuquerque, NM 87131

Physical Location:
917 Vassar Dr. NE
Albuquerque, NM 87106

Phone: (505) 272-4566
Fax: (505) 272-4569

Values History

FamilyIt is important that your medical treatment be of your choice.

The purpose of the Values History Form is to assist you in thinking about and writing down what is important to you about your health. If you should at some time become unable to make health care decisions, this form may help others make a decision for you in accordance with your values.

This Values History Form was developed at the Center for Health Law and Ethics, University of New Mexico School of Law. The form is not a legal document, although it may be used to supplement an Advance Directive such as a Living Will, a Durable Power of Attorney for Health Care, or a Health Care Proxy, if you have these. Also, the Values History Form is not copyrighted, and you are encouraged to make additional copies for friends and relatives to use.

You may download this form for free, providing you attribute it to our Health Sciences Ethics Program and the form is not used in a proprietary or for-profit manner.

This form is not copyrighted; you may make as many copies as you wish.

Why a Values History Form

The Values History Form recognizes that medical decisions we make for ourselves are based on those beliefs, preferences and values that matter most to us: How do we feel about our overall health? What personal relationships in our lives are important to us? How do we feel about independence or dependence? About pain, illness, dying and death? What are our goals for the future?

A discussion of these and other values can provide important information for those who might, in the future, have to make medical decisions for us when we are no longer able to do so.

Further, a discussion of the questions asked on the Values History Form can provide a solid basis for families, friends, physicians and other when making such medical decisions. By talking about these issues ahead of time, family disagreements may be minimized. And when such decisions do need to be made, the burden of responsibility may be lessened because others feel confident of your wishes.

Who should consider preparing a Values History Form?


While we often focus on older people, it is just as important that younger people discuss these issues and make their wishes known. Often some of the most difficult medical decisions must be made on behalf of younger patients. If they had talked with families and friends, the decision makers could feel reassured they were following the patient’s wishes.

We hope this Values History Form is of help to you, your families and friends. Many people have commented that it is important to reflect, not so much on "How I want to die," but rather on "How I want to LIVE until I die."

How do I fill out the Values History Form?

There are a number of ways in which you might begin to answer these questions. Perhaps you would like to write out some of your own thoughts before you talk with anyone else. Or you might ask family and friends to come together and talk about you—and their—responses to the questions.

Often simply giving copies of the Values History Form to others is enough to get people talking about a subject that, for many of us, is difficult and painful to consider.

The most important thing to remember is that it is easier to talk about these issues BEFORE a medical crisis occurs. Feel free to add questions and comments of your own.

What to do with my completed Values History Form?

Make sure that all those who might be involved in your health care are aware of your wishes: family, friends, physicians and other health care providers, your pastor, your lawyer. If appropriate, give written copies to these people.

But remember, each of us continues to grow and change, and so the Values History Form should be discussed and updated fairly regularly.

Consider attaching a copy of it to your Living Will, Durable Power of Attorney, or Health Care Proxy, if you have one, or filing it with your important medical papers.