Getting an advance directive is straightforward and free in most cases. You don’t need a lawyer. The process involves choosing someone to speak for you if you can’t, writing down your medical preferences, signing the documents with witnesses, and distributing copies. Most people can complete everything in an afternoon, though the conversations that come first are worth taking your time with.
What an Advance Directive Includes
An advance directive is actually a package of two legal documents that work together. The first is a living will, which spells out the medical treatments you do or don’t want if you’re unable to communicate. You can specify your preferences for things like mechanical ventilation, tube feeding, pain management, and resuscitation, and you can describe the conditions under which each choice applies (terminal illness, permanent unconsciousness, severe cognitive decline).
The second document is a durable power of attorney for health care, which names a specific person, your health care proxy, to make medical decisions on your behalf when you can’t. The living will covers the scenarios you’ve anticipated. The proxy handles everything else, using their understanding of your values to guide decisions you didn’t explicitly address.
Step 1: Get Your State’s Forms
Every state has its own advance directive laws, so you need forms that comply with your state’s requirements. Several reputable organizations provide free, state-specific forms. CaringInfo, a program of the National Alliance for Care at Home, offers downloadable forms for all 50 states and the District of Columbia. The Five Wishes form is another widely used option that’s legally valid in most states and walks you through your preferences in plain language rather than legal jargon.
Your state attorney general’s office, department of health, or bar association may also have official template forms. Many hospitals and hospice organizations keep copies on hand as well.
Step 2: Choose Your Health Care Proxy
Picking the right person to make decisions for you is the most important part of this process. This person doesn’t need medical knowledge. They need to be someone who will honor your wishes even when it’s emotionally difficult, and who can handle pushback from family members or doctors who may disagree.
When evaluating candidates, consider whether the person lives close enough to get to you quickly, whether you can speak openly with them about death and medical treatment, and whether they can stay composed under pressure. Trust matters more than closeness. A calm, reliable friend may be a better choice than a spouse or child who would be too overwhelmed to advocate clearly.
Most states restrict who can serve as your proxy. The American Bar Association recommends against choosing your doctor or anyone employed by your doctor, the owner or operator of your care facility, anyone from a government agency financially responsible for your care, a court-appointed guardian, or anyone who already serves as proxy for 10 or more other people. Name a backup proxy as well, in case your first choice is unavailable.
Step 3: Decide Your Medical Preferences
This is where people often stall, because it means thinking through scenarios you’d rather not imagine. Start with the big categories: CPR, mechanical ventilation, artificial nutrition and hydration, dialysis, antibiotics for life-threatening infections, and palliative care. For each, consider whether your answer changes depending on your likelihood of recovery.
You can also address conditions beyond the typical terminal illness or permanent unconsciousness scenarios. Some state forms, like Maryland’s, include a category for “end-stage illness,” defined as an advanced, progressive, irreversible condition that has caused complete physical dependency and severe permanent deterioration. This category can cover situations like advanced dementia. If your state’s standard form doesn’t address dementia or prolonged cognitive decline specifically, you can attach supplemental instructions.
Some states let you choose whether your stated preferences should be treated as strictly binding orders or as flexible guidelines your proxy can interpret based on circumstances. If that option is available, think about how much latitude you want your proxy to have. Strict instructions give you more control. Flexible guidelines let your proxy adapt to situations you couldn’t have predicted.
Step 4: Sign With Witnesses (and Possibly a Notary)
Requirements for making your advance directive legally valid vary by state, but nearly all states require either witnesses, notarization, or both. Most states require two adult witnesses to watch you sign. Many states prohibit certain people from serving as witnesses, often the same categories restricted for proxies: your named health care agent, your doctors or their employees, and staff at your care facility. Some states also prohibit anyone who would inherit from your estate.
A handful of states require notarization instead of or in addition to witnesses. Check your state’s specific form, which typically includes signing instructions at the end. You do not need a lawyer to complete or sign an advance directive, though consulting one can help if your situation is complex.
Step 5: Distribute and Store Copies
An advance directive only works if the people who need it can find it. Give copies to your health care proxy, your backup proxy, your primary care doctor, and any specialists who treat you regularly. If you’re being admitted to a hospital or moving into a care facility, bring a copy so it can be added to your medical record. Keep a copy somewhere accessible at home and tell a family member or close friend where it is.
Some states maintain electronic registries where you can upload your documents. Idaho, for example, runs a cloud-based Healthcare Directive Registry that lets you store, create, and share your advance directive with family and providers online. The state even offers a wallet card to alert emergency workers that your directive is on file. Check whether your state offers a similar registry.
Carry a small card in your wallet noting that you have an advance directive and listing your proxy’s name and phone number. In an emergency, this can make the difference between your wishes being followed and being unknown.
POLST Orders for Serious Illness
If you’re already seriously ill or frail, you may also want a POLST form (sometimes called MOLST, depending on the state). This is different from an advance directive. A POLST is a set of actual medical orders, signed by your doctor, that travels with you and must be honored by emergency medical technicians. EMTs cannot follow advance directives or medical powers of attorney, but they are required to follow POLST orders.
A POLST gives specific, actionable instructions about treatments during an emergency: whether to attempt resuscitation, whether to use a ventilator, whether to transfer to a hospital. It doesn’t replace an advance directive, though. A POLST doesn’t name a proxy to speak for you, and it only covers a narrow set of emergency decisions. If you’re healthy, an advance directive alone is sufficient. If you have a serious or progressive illness, having both gives you the most complete coverage.
Keeping Your Directive Current
An advance directive stays in effect indefinitely unless you cancel it or include an expiration date. But your preferences can change after a major diagnosis, a marriage, a divorce, or simply with age. Review your documents every few years and after any significant life event.
You can change or cancel your advance directive at any time. To cancel a health care proxy, notify your agent, your doctor, or anyone who has a copy, either orally or in writing. If your spouse is your proxy and you divorce, the proxy is automatically canceled in many states. To cancel a living will, destroying the document is sufficient, though you should also inform anyone who has a copy. When you update, create an entirely new document with new signatures and witnesses rather than making handwritten edits, then replace all distributed copies with the new version.
If You Spend Time in Multiple States
There is no unified national system for recognizing advance directives across state lines. However, most states have laws that presume an out-of-state directive is valid if it was executed in compliance with either the laws of the state where it was signed or the laws of the state where you’re receiving care. Colorado, for example, presumes that any medical durable power of attorney executed in another state complies with Colorado law and can be relied upon by health care providers. Oregon similarly honors directives executed in compliance with another state’s laws.
If you split time between states or travel frequently, the safest approach is to complete advance directive forms for each state where you spend significant time. At minimum, make sure your primary directive is properly witnessed and notarized, since notarization tends to be the most universally accepted form of authentication.