End of Life Planning Oregon: Complete Checklist

Oregon gives residents more end-of-life options than nearly any other state — a unified advance directive, the nation's first POLST program, the Death with Dignity Act, and legal alternative disposition methods including human composting and water cremation. The challenge isn't lack of options. It's knowing which ones apply to your situation and completing them in the right order.

The Planning Checklist

Step 1: Complete Your Advance Directive

Every Oregon adult over 18 should complete Form OHA 3905, the state's statutory Advance Directive. This single document handles both:

• Health Care Representative appointment — naming the person who makes medical decisions if you can't
• Treatment instructions — your preferences for life-sustaining treatment in terminal, progressive, and permanent unconsciousness scenarios

The form requires your signature plus either two qualified witnesses or a notary. Your representative must also sign the Acceptance section (Section 7) for the appointment to take effect.

Timing note: If you're scheduled for surgery, complete your advance directive before the procedure. Hospitals routinely ask whether you have one during pre-surgical intake. Having it done eliminates a stressful last-minute scramble and ensures your preferences are documented if complications arise.

Step 2: Distribute Your Directive

A completed directive that no one can find is as useful as no directive at all:

• Give copies to your Health Care Representative and alternates
• File with your primary care physician
• Upload to your MyChart patient portal (OHSU, Providence, Legacy, Kaiser, Samaritan)
• Keep the original at home in an accessible, visible location
• Carry a wallet card referencing your directive and representative

Step 3: Evaluate Whether You Need a POLST

A POLST (Portable Orders for Life-Sustaining Treatment) converts your wishes into active medical orders that EMTs must follow immediately. You need one if:

• You have a serious illness and your doctor would not be surprised if you died within a year
• You're entering hospice care
• You're being admitted to a skilled nursing or memory care facility
• You want a DNR order that first responders will honor at home

If you're healthy and planning ahead, an advance directive is sufficient. POLST is for when the medical situation is already serious.

Step 4: Understand the Death with Dignity Act

Oregon's DWDA (ORS 127.800-127.897) allows terminally ill adults to obtain life-ending medication. Key requirements:

• Terminal diagnosis with six months or less to live
• Decision-making capacity at the time of each request
• Confirmed by two independent Oregon-licensed physicians
• Two oral requests separated by at least 15 days, plus a witnessed written request

The DWDA cannot be activated through an advance directive or by a proxy. The patient must make all requests personally while competent. This is a separate legal track from advance directive planning, but many people pursuing the DWDA also complete an advance directive as a backup.

Step 5: Address Body Disposition Preferences

Oregon allows several disposition options beyond traditional burial and cremation:

• Natural organic reduction (human composting) — legal under HB 2574, regulated by the Oregon Mortuary and Cemetery Board. The process takes 8-12 weeks and produces approximately one cubic yard of soil.
• Alkaline hydrolysis (water cremation) — also legalized under HB 2574. Uses water, heat, and potassium hydroxide for decomposition.
• Home burial — permitted on private land in Oregon, with graves dug to allow at least 18 inches of soil coverage.
• Green burial — burial without embalming, in biodegradable caskets or shrouds.

If you want an alternative disposition method, document it in Section 4 of your advance directive and discuss it with your Health Care Representative. Your representative needs to know your preferences and how to coordinate logistics — especially for natural organic reduction, which may require transport to facilities in Washington state.

Step 6: Review Your Estate Tax Exposure

Oregon imposes a state estate tax starting at a gross estate value of $1,000,000 — one of the lowest thresholds in the country. The exemption is not indexed for inflation and does not allow spousal portability (a surviving spouse cannot use the deceased spouse's unused exemption).

This means many middle-class Oregon homeowners, especially in the Portland, Bend, and Eugene metro areas, cross the threshold without realizing it. If your combined estate (home value, retirement accounts, life insurance, investments) exceeds $1 million, estate tax planning should be part of your end-of-life preparation.

The estate tax return (Form OR-706) must be filed within nine months of death.

Step 7: Check Medicaid Recovery Exposure

If you or a family member received long-term care through Oregon Health Plan (Medicaid) after age 55, the Oregon Department of Human Services can seek recovery from the estate. Oregon uses an expanded estate definition — recovery can reach assets in living trusts, joint tenancies, life estates, and transfer-on-death deeds, not just probate assets.

Key protections exist: recovery is deferred while a surviving spouse is alive, blocked if a minor or disabled child survives the decedent, and blocked against the home if a qualifying sibling or caregiver child resides there. An undue hardship waiver is also available.

Step 8: Pre-Surgery Planning

If you're facing a scheduled surgery without an advance directive, prioritize Steps 1 and 2 immediately. Surgical complications — while rare — can result in temporary or permanent incapacity. An advance directive completed before surgery ensures:

• Your chosen representative makes decisions, not the default surrogate hierarchy
• Your preferences for life support, ventilation, and resuscitation are documented
• Hospital staff have clear instructions if you can't communicate post-surgery

Most hospitals accept an advance directive completed the same day as surgery, but completing it at least a week in advance gives you time to distribute copies properly.

Start With the Foundation

The Oregon Advance Directive & Living Will Kit covers Steps 1-3 in detail: plain-language instructions for Form OHA 3905, a witness selection checklist, POLST coordination guidance, and a distribution tracker. It's the foundational document everything else builds on.

See more Oregon guides →