Advance directives are legal documents that record your healthcare wishes in advance — so that if you're ever unable to communicate them yourself, medical providers and your loved ones know exactly what to do. They are one of the most compassionate things you can do for your family, removing an enormous burden from people who already love you and are already in pain.
This guide covers the main types of advance directives, how they work, how to create them, and what to do with them once they're signed.
Why Advance Directives Matter
Without advance directives, medical providers follow standard protocols in emergency situations. Your family members may be asked to make decisions they aren't prepared for — and they may disagree with each other about what you would have wanted. These disputes can fracture relationships and result in care that doesn't reflect your values.
The goal of advance directives isn't to plan for death — it's to ensure your voice is heard even when you can't speak.
The Main Types of Advance Directives
Living Will
A living will documents your preferences about specific medical treatments — what you want, and what you don't want — in scenarios where you can't communicate. This might include preferences about:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Artificial nutrition and hydration (feeding tubes)
- Dialysis
- Comfort care and pain management
- Organ donation
Healthcare Proxy (Healthcare Power of Attorney)
A healthcare proxy designates a specific person — your "healthcare agent" — to make medical decisions on your behalf when you can't. This person should know your values deeply and be trusted to advocate for your wishes even under pressure from medical providers or other family members.
POLST Form
A POLST form (Physician Orders for Life-Sustaining Treatment) is a physician's order — not just a preference statement — that travels with you across care settings. It's particularly important for people with serious illness or advanced age who receive care in multiple settings.
Do-Not-Resuscitate (DNR) Order
A DNR order is a specific medical instruction telling providers not to perform CPR if your heart stops. It's a component that can appear in a living will or POLST form, or as a standalone document for patients in certain care settings.
How to Create Advance Directives
The process varies slightly by state, but generally involves:
- Reflecting on your values: Think about what quality of life means to you, what treatments you would or wouldn't want, and what scenarios are most important to address.
- Choosing your healthcare proxy: Select someone who knows you well, will be available, and can advocate forcefully for your wishes.
- Completing the forms: Use your state's official form, or work with an attorney. Most state health department websites offer free forms. The Five Wishes document is a popular option accepted in most states.
- Signing with proper witnesses: Requirements vary by state — typically two adult witnesses who are not your healthcare agent, not related to you by blood or marriage, and not entitled to inherit from your estate. See our guide to advance directive state laws.
- Distributing copies: Give copies to your healthcare proxy, your primary physician, any specialist physicians, your hospital if you're admitted, and keep one at home. See our guide to storing and sharing legal documents.
Talking to Your Doctor
An advance directive is most effective when your physician has read it, understands your values, and has it in your medical record. See our guide on talking to your doctor about end-of-life wishes for how to have this conversation.
Keep Them Updated
Review your advance directives every few years or after major health changes. Your values and preferences may evolve — and your documents should reflect where you are now, not where you were a decade ago.