A health care directive is a legal document that spells out your medical treatment preferences in case you become unable to communicate them yourself. It only takes effect if you lose the ability to make your own decisions, whether from a medical emergency, serious illness, or cognitive decline. There are two main types, and most people benefit from having both.
The Two Types of Health Care Directives
Health care directives generally come in two forms: a living will and a durable power of attorney for health care. They serve different purposes and cover different situations.
A living will is a written document that details the specific medical treatments you would or would not want if you were dying or permanently unconscious. It gives your doctors direct instructions, but it can only address scenarios you anticipated in advance.
A durable power of attorney for health care (sometimes called a medical power of attorney) names another person, your health care proxy, to make medical decisions on your behalf. This person steps in when you can’t speak for yourself and can respond to situations your living will didn’t cover. Because medical crises are unpredictable, many legal experts consider this the more flexible and important of the two documents.
You can have both. In fact, having both gives you the strongest protection: the living will provides clear guidance on your core wishes, while your proxy handles everything else using their knowledge of your values.
What a Living Will Typically Covers
A living will lets you accept or refuse specific life-prolonging treatments. Common decisions addressed include:
- CPR: Whether you want resuscitation if your heart or breathing stops
- Mechanical ventilation: Whether you want a breathing machine to keep you alive
- Tube feeding: Whether you want nutrition and fluids delivered through a tube if you can’t eat
- Dialysis: Whether you want a machine to filter your blood if your kidneys fail
- Organ and tissue donation: Whether you want to donate after death
- Comfort care: Instructions to prioritize keeping you comfortable and free of pain, even if that care shortens or prolongs the dying process
Comfort care includes things like bathing, repositioning, and keeping your lips moist. You can specify that you want to be kept as comfortable and pain-free as possible regardless of what happens to other treatments. Many directives let you set different preferences for different scenarios, such as a terminal illness versus a persistent vegetative state.
Choosing a Health Care Proxy
Your proxy (also called a health care agent, surrogate, or representative) takes on significant responsibility. Their role goes beyond a single yes-or-no decision. A proxy’s typical responsibilities include deciding what medical care, procedures, and treatments you receive, choosing your health care providers and care facilities, accessing your medical records, and in some cases making decisions about organ donation, autopsy, and what happens to your body after death. If a guardian is ever needed, your proxy may be appointed to that role as well.
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 avoiding certain people for this role: your health care provider or their employees, the owner or operator of your residential care facility, anyone employed by a government agency financially responsible for your care, someone evaluating your decision-making capacity, your court-appointed guardian, or anyone already serving as proxy for 10 or more other people.
The best proxy is someone who knows your values, can handle stressful conversations with medical teams, and will follow your wishes even if they personally disagree. Having a frank conversation with this person before anything happens is just as important as the paperwork itself.
Making Your Directive Legally Valid
Requirements vary by state, but most states require your directive to be a written document that is dated and signed by you in the presence of two witnesses. Some states also require notarization, while others (like Pennsylvania) do not. If you travel frequently, getting your documents notarized is a practical safeguard since another state’s rules may differ from your home state’s.
You do not need an attorney to create a health care directive, though consulting one can help if your situation is complicated or you want to make sure your documents comply with your state’s specific rules. Many hospitals, state health departments, and organizations like the American Bar Association offer free or low-cost forms.
How a POLST Differs From a Directive
You may have heard of a POLST (Physician Orders for Life-Sustaining Treatment), sometimes called a MOLST in certain states. This is not the same thing as a health care directive, though the two can work together.
A health care directive is written by you, applies to all adults regardless of health status, and expresses your preferences. A POLST is written by a doctor (or in some states, a nurse practitioner or physician assistant) and contains actual medical orders. It’s designed for people with a serious illness or frailty where death within the next year or two would not be surprising.
One key practical difference: a POLST applies to emergency care, so paramedics and emergency responders follow it. A standard health care directive generally does not guide emergency responders. A POLST also travels with you through the health care system, with the medical team responsible for making sure it’s available wherever you receive care. With a health care directive, that responsibility falls on you and your family.
If you have a serious illness, having both documents gives the most complete coverage. The directive communicates your broader goals and names a proxy, while the POLST translates your current medical situation into specific orders.
Storing and Sharing Your Documents
A directive that nobody can find when it matters is essentially useless. Give copies to your health care proxy, your primary care provider, and any specialists involved in your ongoing care. If you’re admitted to a hospital or enter a care facility, bring a copy or make sure one is added to your medical record. Keep the original somewhere accessible, not locked in a safe deposit box that your proxy can’t reach in an emergency. Some people also give copies to close family members to reduce confusion during a crisis.
Changing or Revoking a Directive
You can change or revoke your health care directive at any time, as long as you still have the mental capacity to do so. No one can override your wishes while you’re able to express them yourself. Revocation can be done orally or in writing, but putting it in writing and notifying your proxy, your doctor, and anyone else who holds a copy is the safest approach.
If you want to update your preferences rather than cancel the directive entirely, the simplest route is to create a new document from scratch. An amendment requires the same signature and witness formalities as a brand-new directive, so starting fresh avoids confusion about which version is current. It’s worth revisiting your directive after any major life change: a new diagnosis, a marriage or divorce, or the death of your named proxy.