Making an advance directive is a straightforward process that most people can complete in an afternoon without a lawyer. An advance directive is a legal document that spells out your medical care preferences in case you ever can’t speak for yourself. It typically has two parts: a living will, which states what treatments you do or don’t want, and a healthcare power of attorney, which names someone to make decisions on your behalf. Here’s how to put one together, step by step.
Understand the Two Parts
A living will covers specific medical scenarios. It’s where you state your preferences about life-sustaining treatments: mechanical ventilation (a breathing machine), CPR, artificial nutrition and hydration through a feeding tube, dialysis, and comfort-focused care like pain management. You can also address organ donation and whether you’d want aggressive treatment in situations like a permanent coma or terminal illness.
A healthcare power of attorney (also called a healthcare proxy or medical durable power of attorney) names a person to make medical decisions when you can’t. This person steps in for situations your living will doesn’t specifically cover, which is inevitable since no document can anticipate every scenario. Together, these two documents form a complete advance directive, though some states combine them into a single form.
Choose Your Healthcare Proxy Carefully
Your proxy must be at least 18 in most states (19 in Alabama and Nebraska) and of sound mind. Beyond the legal minimum, the person you choose matters more than almost any other decision in this process. Ask yourself a few questions: Will this person actually follow your wishes, even if they personally disagree? Can they handle pressure from family members or doctors who might push back? Are they available, either living nearby or willing to travel quickly if needed?
The American Bar Association recommends against choosing your healthcare provider or their spouse, the owner or operator of your care facility, anyone employed by a government agency responsible for your care, or a court-appointed guardian. You should also avoid anyone who already serves as proxy for 10 or more other people. The best proxy is someone you trust completely, who you’ve had honest conversations with about your values, and who can stay calm under stress. Many people choose a spouse, adult child, or close friend.
Get Your State’s Form
Every state has its own advance directive form and requirements. You can find your state’s form through several reliable sources: your state attorney general’s or secretary of state’s website, your healthcare provider’s office, or nonprofit organizations like the National Hospice and Palliative Care Organization (NHPCO), which offers free state-specific forms through its CaringInfo program. Your hospital’s admissions or social work department can often hand you the right paperwork too.
You don’t need a lawyer, though consulting one is an option if your situation is complex, such as blended families with potential disagreements or significant assets tied to care decisions. For most people, the standard state form is sufficient.
Fill Out Your Medical Preferences
This is the part that requires the most thought. Your form will ask you to consider scenarios where you’re terminally ill, permanently unconscious, or unable to make decisions, and then state what treatments you would or wouldn’t want in each case. Common decisions include:
- CPR and resuscitation: Whether you want medical staff to attempt to restart your heart and breathing.
- Mechanical ventilation: Whether you want a machine to breathe for you if you can’t breathe on your own.
- Artificial nutrition and hydration: Whether you want fluids and food delivered through a tube or IV.
- Comfort care: Whether your priority is pain relief and quality of life rather than extending life as long as possible.
- Organ and tissue donation: Whether you’d like to donate organs after death.
Don’t just check boxes. Most forms include space for personal statements, and this is where you can describe your values in your own words. Phrases like “I would not want to be kept alive if I had no reasonable chance of meaningful recovery” give your proxy and doctors important context for the gray areas that a checklist can’t capture. Think about what quality of life means to you: Is it the ability to recognize family? To live without constant pain? To communicate in any form? Writing this down helps everyone involved.
Have the Conversation Before You Sign
A form sitting in a drawer doesn’t help anyone. Before finalizing your directive, talk with the people who need to know about it: your healthcare proxy, your close family members, and your doctor. These conversations can feel uncomfortable, but they dramatically increase the chances your wishes are actually followed.
The National Institute on Aging suggests simple conversation starters with your doctor: “I want to have a conversation about my wishes for end-of-life care,” or “I’ve been thinking about my health and I’d like to talk about how to prepare for future medical decisions.” Share what matters most to you. If you’ve watched a loved one go through a difficult end-of-life experience, mention it. If there’s a milestone event you want to be present for, say so. These details help your doctor give you realistic guidance about what care options align with your goals.
Talk with your proxy separately. Make sure they understand not just what you want, but why. A proxy who understands your values can make better judgment calls in unexpected situations than one who only memorized a list of yes-or-no preferences.
Sign It With the Right Formalities
Advance directives must be in writing and signed. Beyond that, requirements vary by state. Some states require two adult witnesses who watch you sign. Some require notarization. Many require both. Witnesses typically cannot be your healthcare proxy, your doctor, or anyone who would inherit from your estate, though specific disqualifications differ by state. Check your form’s instructions carefully, as missing a witness signature or notary stamp can make the document legally unenforceable.
Distribute Copies Widely
A completed advance directive only works if the right people can find it at the right time. Research published in the Journal of Pain and Symptom Management found that even when advance directives exist in hospital records, emergency department staff often struggle to locate them. Documents get lost in transitions between home, nursing facilities, and hospitals, or they’re filed in inconsistent locations within electronic health records.
To minimize this risk, give copies to your healthcare proxy, your primary care doctor, any specialists you see regularly, and close family members. If you’re being admitted to a hospital or moving into a care facility, hand them a copy directly and ask that it be scanned into your chart. Many hospitals now have patient portals where you can upload documents to your medical record yourself. Keep the original in a place your proxy can access quickly (not a safe deposit box, which may be difficult to open in an emergency).
Some states maintain advance directive registries. California, for example, runs one through the Secretary of State’s office. These registries allow healthcare providers to look up your directive electronically, which can be especially useful in emergencies.
Know the Difference: Advance Directive vs. DNR vs. POLST
An advance directive is a broad planning document. A do-not-resuscitate (DNR) order is a specific medical order, signed by a doctor, that goes into your hospital chart and tells staff not to perform CPR if your heart stops. Even if your living will says you don’t want CPR, having a separate DNR posted in your medical chart avoids confusion during a fast-moving emergency.
A POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) is another type of medical order, typically created when someone is near the end of life or critically ill. Unlike an advance directive, a POLST is an actionable medical order that paramedics and emergency staff can follow immediately. It complements your advance directive rather than replacing it. You create a POLST with your doctor when the specific decisions it covers are likely to come up soon.
If You Move to Another State
All 50 states and the District of Columbia recognize advance directives, but there’s no unified system for honoring documents across state lines. Many states will accept an out-of-state directive, but some may question its validity if the form doesn’t match local requirements. Colorado, for instance, presumes that a directive from another state is valid as long as it was properly executed where it was created and doesn’t violate Colorado law. Not every state is that accommodating.
If you move permanently, the safest approach is to complete a new advance directive using your new state’s form. If you split time between two states, consider having valid directives in both. At minimum, confirm that your existing directive meets the witness and notarization requirements of any state where you receive medical care.
When to Update Your Directive
An advance directive isn’t a one-time task. Review yours after any major life change: a new diagnosis, a marriage or divorce, the death of your named proxy, a move to a new state, or a shift in how you feel about quality of life and medical intervention. Even without a specific trigger, reviewing it every few years ensures it still reflects your current values. Your preferences at 45 may not match your preferences at 70. To update, complete a new form, sign it with the required formalities, and distribute fresh copies to everyone who had the old version. Let your proxy and doctors know the previous version is no longer current.