Advance care planning is the process of thinking about, discussing, and documenting your preferences for medical care in case you ever become too ill or incapacitated to speak for yourself. It combines two things: conversations with the people closest to you about what matters most, and legal paperwork that turns those wishes into instructions a medical team can follow. Despite its importance, only about one in three U.S. adults has completed any form of advance directive.
Conversations Come First
The most important part of advance care planning isn’t paperwork. It’s talking with your family, your partner, or whoever would be making decisions on your behalf. These conversations don’t need to start with specific medical scenarios. You can begin with broader values: what quality of life means to you, how you feel about being kept alive on machines, whether staying at home matters more than aggressive treatment, or what trade-offs you’d accept to reach a personal milestone.
Some people find it easier to open the door with their doctor first. Useful starting points include questions like “What should I expect from this condition in the years ahead?” or “What would you recommend if your own family member had this diagnosis?” You can also simply tell your doctor, “I’ve been thinking about my health and I’d like to talk about how to prepare my family for future medical decisions.” These conversations aren’t one-time events. They evolve as your health, relationships, and priorities change.
The Two Core Legal Documents
Once you’ve reflected on your values, putting them in writing gives them legal weight. The two most common advance directives are a living will and a healthcare power of attorney.
A living will spells out which medical treatments you do and don’t want if you can’t make decisions yourself. It covers things like CPR, ventilators, feeding tubes, pain management, and organ donation. You can specify under which conditions each choice applies, so it’s not just a blanket yes or no.
A healthcare power of attorney (also called a healthcare proxy) names a specific person to make medical decisions on your behalf when you can’t communicate. This person, your agent or surrogate, should understand your values well enough to make choices you’d agree with, even in situations your living will didn’t anticipate. Choosing someone you trust deeply matters more than choosing someone with medical knowledge.
These two documents work together. The living will covers the scenarios you’ve thought through in advance. The healthcare proxy handles everything else.
When These Documents Take Effect
Advance directives only activate when you lose the ability to make your own medical decisions. That determination is made by your treating physician, who evaluates four things: whether you can understand the benefits and risks of a proposed treatment, whether you appreciate how those apply to your situation, whether you can reason through a decision, and whether you can communicate your choice. If all four are intact, your advance directives stay in the background and you remain in control.
Physicians look for reversible causes first. An infection, a medication side effect, or delirium can temporarily impair someone’s capacity. If the cause is treatable, the goal is to restore your ability to decide for yourself rather than immediately turning to surrogate decision-makers.
POLST: A Different Kind of Document
You may hear about a form called POLST (Physician Orders for Life-Sustaining Treatment), sometimes called MOLST depending on your state. This is not the same as an advance directive. A POLST is a set of actual medical orders written by a doctor, typically for someone with a serious illness who may realistically die within the next year or two.
The practical differences are significant. Advance directives are written by you, apply to any adult regardless of health, and express preferences. A POLST is created in a medical setting by a clinician, translates your general wishes into specific medical orders, and applies to emergency situations in a way standard advance directives generally do not. Emergency responders, for instance, follow POLST orders. A POLST complements your advance directives rather than replacing them.
Other Medical Orders to Know About
Beyond a living will and healthcare proxy, several specific orders can become part of your medical chart:
- DNR (Do Not Resuscitate): Tells hospital or nursing facility staff not to attempt CPR or other life-support measures if your heart stops.
- DNI (Do Not Intubate): Tells medical staff you do not want to be placed on a ventilator.
- DNH (Do Not Hospitalize): Used mainly in long-term care settings, this indicates you prefer not to be transferred to a hospital for treatment at the end of life.
These are not documents you fill out at home. They’re medical orders placed in your chart after a discussion with your care team, and they reflect decisions that should flow from the broader planning you’ve already done.
Legal Requirements Vary by State
There is no single national standard for making an advance directive legally valid. Some states require two witnesses when you sign. Others require notarization. Some require both, and a few require neither. The documents themselves may even have different names depending on where you live. Because of this variation, it’s worth looking up your own state’s requirements or using your state’s official advance directive form. Many state health departments and bar associations provide these for free.
Even in states where witnesses aren’t technically required, having them strengthens the document’s credibility if it’s ever challenged. Your witnesses generally cannot be the same person you’ve named as your healthcare proxy.
Medicare Covers These Conversations
If you’re on Medicare, advance care planning discussions with your doctor are a covered benefit under Part B. These are voluntary, face-to-face conversations where a physician, nurse practitioner, or physician assistant explains advance directives, helps you think through your options, and can assist with completing forms.
When the conversation happens during your Annual Wellness Visit, Medicare waives your copay and deductible entirely. If it happens at a separate appointment, normal Part B cost-sharing applies. There’s no limit on how many times you can have these conversations, but if you do it more than once, your doctor needs to document a change in your health status or your wishes.
How to Start and When to Update
You don’t need a terminal diagnosis or even a health scare to begin. Any adult can and probably should have at least a healthcare proxy and a basic living will. The process looks like this: reflect on what matters most to you, choose a healthcare proxy and talk with them honestly, write down your wishes using your state’s advance directive forms, and make sure copies reach your doctor, your proxy, and anyone else who might need them. Keep a copy accessible at home, too.
Plans aren’t permanent. Review your documents after any major life change: a new diagnosis, a hospitalization, a divorce, a move to a new state, the death of your named proxy, or even a shift in how you think about quality of life. What felt right at 45 may not reflect your priorities at 70. The goal isn’t to get the paperwork perfect once. It’s to keep a living conversation going with the people who matter most, backed by documents that reflect where you actually are right now.