We all know that tomorrow is promised to no one. Heart attacks, strokes and auto accidents can happen to anyone at anytime and as medicine gets better at early diagnosis, we are learning sooner about the presence of a catastrophic illness. With early knowledge, we can plan for how the development and consequences of such a diagnosis can be handled so that our preferences and values can be honored and that our quality of life during a difficult time can be optimized in legally effective and enforceable manner.