An advance directive is a written instruction about medical care you want (or don’t want) if you become unable to communicate your wishes. It comes into play when you can’t speak for yourself — after a serious accident, during late-stage dementia, after a stroke. Without one, doctors and your family have to guess what you would have wanted, often during the most stressful moments. The document is free to prepare in every state, and most hospitals are required to ask you for one at admission.
The Three Main Documents
- Living will — spells out your wishes about specific medical treatments. Most commonly addresses end-of-life decisions: do you want CPR, mechanical ventilation, feeding tubes, dialysis, artificial nutrition and hydration in specific terminal or permanently unconscious situations?
- Healthcare power of attorney (also called a healthcare proxy or medical POA) — names a person who can make medical decisions on your behalf when you can’t. See our broader power of attorney guide. Often more practical than a living will because it covers situations the living will didn’t anticipate
- POLST or MOLST form (Physician/Medical Orders for Life-Sustaining Treatment) — a portable medical order signed by you and a physician, used for seriously ill or frail patients. Travels with you across care settings (home, hospital, nursing facility) and is honored by EMTs
Most complete plans include both a living will and a healthcare POA — the living will gives the doctor a clear written record of your specific wishes, and the healthcare POA names someone who can advocate for you and handle situations the living will didn’t anticipate.
When a Living Will Takes Effect
Two conditions typically must be met:
- You’re unable to communicate your wishes (unconscious, demented, severely impaired)
- Your condition meets a specific threshold defined in the document — usually one or more of: terminal illness, permanently unconscious, end-stage condition
For most temporary medical situations — surgery, a treatable illness, a recoverable injury — the living will isn’t triggered, and treatment decisions go through your healthcare agent or family in the normal way.
Common Decisions Addressed
- Cardiopulmonary resuscitation (CPR) — do you want it attempted? CPR success rates in elderly and seriously ill patients are lower than most people think, and outcomes often include broken ribs, brain damage, and prolonged hospitalization
- Mechanical ventilation — do you want a breathing machine if you can’t breathe on your own? For how long?
- Artificial nutrition and hydration — feeding tubes, IV fluids. Particularly relevant for patients with advanced dementia or permanent unconsciousness
- Dialysis — do you want kidney dialysis if your kidneys fail?
- Antibiotics — do you want them in late stages of a terminal illness, when infection might be a peaceful exit?
- Comfort care vs. aggressive treatment — do you prefer being kept comfortable (pain managed, dignity preserved) over treatment aimed at extending life?
- Organ and tissue donation — can be included or addressed separately on your driver’s license / state registry
- Religious or spiritual preferences — clergy visits, last rites, specific care preferences
Where to Get One
- Your state’s health department — most offer free downloadable forms specific to your state’s law. Search “[your state] advance directive form”
- AARP — free state-by-state forms at aarp.org
- Five Wishes — a widely used and accessible alternative (fivewishes.org) that’s legally valid in nearly all states. Costs ~$5
- Your hospital, hospice, or primary care office — required to provide forms and discuss them with patients
- An estate-planning attorney — usually includes advance directives in the basic estate-plan package
Most state forms can be completed without a lawyer. They typically require two witnesses (with restrictions on who can serve — usually not family members or healthcare providers involved in your care) and sometimes notarization.
After You Sign — Where to Put It
- Give copies to your healthcare agent and backup agent — the people who’ll need to act on it
- Give a copy to your primary care doctor — they should add it to your medical record
- File one with your hospital if you’ve been admitted recently or expect to be
- Keep the original somewhere accessible — not locked in a safe deposit box (the agent may need it on weekends or evenings). A home safe with the agent knowing the combination is fine
- Carry a wallet card noting you have an advance directive and listing your healthcare agent’s contact info. Some states have a registry where you can store yours
- Tell your family — even close family members are often surprised by the decisions in an advance directive. Have the conversation while you can still discuss it together
Revoking or Changing It
You can revoke or change an advance directive at any time, by any clear means: telling your doctor, physically destroying the document, signing a written revocation, or simply signing a new advance directive that supersedes the old one. Re-distribute the new version to everyone who had the old one.
Review every few years and after major health changes. Wishes you held at 50 may differ from those at 75 after living with a chronic condition.
Educational only. Estate-planning laws — including which documents are valid, who can serve as executor or agent, witness and notary requirements, and how assets pass — vary significantly by state. This article is not legal advice. Consult a licensed attorney in your state before drafting or relying on any estate document.