The three main types of advance directives are a living will, a healthcare power of attorney, and a physician orders for life-sustaining treatment (POLST) form. Each serves a different purpose, and together they give you a comprehensive plan for medical decisions if you ever become unable to speak for yourself. Some people only need one or two of these documents, while others benefit from all three.
Living Will
A living will is a written legal document that spells out which medical treatments you do and don’t want used to keep you alive. It only takes effect when you cannot make decisions yourself, typically because you’re unconscious, in a coma, or otherwise incapacitated. The key purpose is to give your medical team clear instructions when you can’t communicate directly.
The treatments you can address in a living will include mechanical ventilation (a breathing machine), CPR, dialysis, artificial nutrition and hydration through a feeding tube, and whether you want antibiotics or pain medication in certain situations. You can accept some of these treatments and refuse others. For example, you might want pain management but not a breathing machine. The more specific you are, the easier it is for your care team to honor your wishes.
Every state has its own form and legal requirements for living wills. In Colorado, for instance, two witness signatures are mandatory. Other states may require notarization. Regardless of where you live, your living will needs to be in writing to be legally valid.
Healthcare Power of Attorney
A healthcare power of attorney, also called a healthcare proxy, is a document that names a specific person to make medical decisions on your behalf when you’re too sick to make them yourself. Unlike a living will, which covers predetermined scenarios, a proxy can respond to unexpected situations in real time.
The scope of your proxy’s authority can be broad or narrow, depending on what you specify. Common responsibilities include deciding the types of medical care and treatments you receive, choosing your healthcare providers and facilities, accessing your medical records, and making decisions about organ donation, autopsy, and what happens to your body after death. In some cases, a proxy can even become your legal guardian if one is needed.
Choosing the right person matters. In most states, your proxy must be at least 18 years old (19 in Alabama and Nebraska) and mentally competent. The American Bar Association recommends against choosing your healthcare provider or their spouse, the owner or operator of your care facility, someone employed by a government agency paying for your care, or anyone already serving as proxy for 10 or more other people. The best choice is someone who understands your values, can handle pressure, and is willing to advocate for your preferences even when that’s difficult.
Your proxy only gains decision-making power when you’re unable to decide for yourself. Once you recover capacity, you resume making your own choices.
POLST (Physician Orders for Life-Sustaining Treatment)
A POLST form goes by different names depending on your state. You may see it called provider orders for life-sustaining treatment or medical orders for life-sustaining treatment (MOLST). What sets a POLST apart from the other two directives is that it’s a medical order signed by both you and your healthcare provider, not just a legal document you fill out on your own.
POLST forms are designed for people who already have a serious illness. They translate your treatment preferences into actionable medical orders that emergency responders and hospital staff can follow immediately. Because it’s a physician order, it carries more immediate clinical weight than a living will, which may need to be located and interpreted during an emergency. A POLST does not replace your living will or healthcare power of attorney. It works alongside them.
Related but separate from a POLST are do-not-resuscitate (DNR) and do-not-intubate (DNI) orders. You don’t need any advance directive to establish these. Simply tell your healthcare provider your preferences, and they’ll write the orders directly into your medical record. One important detail: it’s a good idea to set up DNR or DNI orders each time you’re admitted to a new hospital or facility, since they don’t automatically transfer.
Psychiatric Advance Directives
While the three types above cover most medical situations, there’s a fourth form worth knowing about if you or someone you care about lives with a mental health condition. A psychiatric advance directive (PAD) is a legal tool that lets a person state their preferences for mental health treatment before a crisis occurs. It protects your autonomy during a period when you may temporarily lose the ability to make or communicate decisions.
A PAD typically has two parts: written instructions about specific treatments you consent to or refuse (such as particular medications or hospitalization) and a healthcare power of attorney for mental health decisions. It goes into effect when a treating physician or psychologist determines you currently lack decision-making capacity, and it ends as soon as you regain that capacity.
All 50 states allow competent adults to document some form of advance planning for mental health treatment, usually through a durable power of attorney for healthcare. Beyond that, 27 states have enacted specific PAD statutes that give people a formal legal mechanism to declare treatment preferences for psychiatric care. Healthcare providers also have obligations to follow PADs under the federal Patient Self-Determination Act, which applies to any facility participating in Medicare or Medicaid.
Making Your Directives Accessible
An advance directive that no one can find when it matters is essentially useless. The most common problem isn’t creating these documents. It’s making sure they’re available to the right people at the right time.
Several options exist for storing your directives where they can be retrieved quickly. The U.S. Living Will Registry, established in 1996, electronically stores advance directives and makes them available to healthcare providers around the clock. Documents are scanned into read-only PDF files so they can’t be altered. Registered healthcare providers search the database using your name, birth date, or a registrant ID number printed on a wallet-sized card you carry. Hospitals, nursing facilities, hospices, and home health agencies can request copies by fax or secure encrypted connection after their identity is verified.
Some states also maintain their own registries. Whether you use a registry or not, give copies to your healthcare proxy, your primary care provider, and any hospital where you receive regular care. Keep the originals in a place your family knows about, and let your proxy know exactly where they are.
How These Documents Work Together
Each type of advance directive fills a gap the others can’t. A living will gives specific instructions but can’t anticipate every medical scenario. A healthcare proxy can adapt to unexpected situations but needs guidance about your values and preferences. A POLST translates your wishes into immediate medical orders but only applies to people with serious illness.
The strongest approach is combining a living will with a healthcare power of attorney, and adding a POLST if you have a serious diagnosis. Having all relevant documents in place means your care team has both written instructions and a trusted person who can interpret your wishes when the instructions don’t cover the exact situation at hand. State requirements vary for each document, so check your state’s specific forms, witness rules, and notarization requirements before completing them.