An advance care plan is a set of legal documents and personal decisions that spell out what medical care you want if you ever become too sick or injured to speak for yourself. These documents only take effect when you can’t communicate your own wishes. The process also involves choosing someone you trust to make healthcare decisions on your behalf and having honest conversations with that person and your doctors about your values.
The Two Core Legal Documents
Most advance care plans center on two documents: a living will and a durable power of attorney for health care.
A living will tells your doctors how you want to be treated during a medical emergency when you can’t make your own decisions. You can specify which common treatments you would want, which ones you’d want to avoid, and under what conditions each choice applies. This covers things like whether you’d want to be placed on a ventilator, receive tube feeding, or undergo CPR in various scenarios.
A durable power of attorney for health care names a specific person, sometimes called a healthcare proxy, agent, or surrogate, who can make medical decisions for you when you’re unable to. This person should know your values and preferences well enough to make choices you’d be comfortable with, even in situations your living will doesn’t specifically address. Picking the right proxy matters more than most people realize: it’s not always your spouse or oldest child, but whoever can best advocate for what you actually want under pressure.
What You Can Include
Advance care plans can go well beyond the basics of life-sustaining treatment. A widely used framework called Five Wishes breaks the planning process into five areas:
- Who decides for you: the person you want making care decisions when you can’t
- What medical treatment you want or don’t want: your preferences for specific interventions
- How comfortable you want to be: your wishes around pain management, hygiene, and physical comfort
- How you want people to treat you: whether you want music playing, someone holding your hand, or to be kept at home if possible
- What you want your loved ones to know: messages of forgiveness, love, or practical instructions
This kind of detail helps your proxy and medical team understand not just your clinical preferences but the kind of care experience that matters to you. You don’t have to use the Five Wishes form specifically, but thinking through these categories gives you a much more complete plan than a bare-bones legal template.
How It Differs From a POLST
You may have heard of a POLST (Physician Orders for Life-Sustaining Treatment), sometimes called MOLST in certain states. This is a different kind of document. An advance directive is something you create on your own or with a lawyer. A POLST is an actual medical order, signed by your doctor, that tells emergency responders and hospital staff exactly what to do right now. It’s typically used for people who are already seriously ill or nearing the end of life. Think of your advance care plan as the long-term strategy and a POLST as the immediate set of instructions for first responders.
Making It Legally Valid
Requirements for making an advance directive legally binding vary by state. Some states require witness signatures, others require notarization, and some accept both or allow online notarization. Before signing your documents, review your state’s specific rules carefully. CaringInfo, a program run by the National Hospice and Palliative Care Organization, offers free state-specific forms and instructions that walk you through the requirements where you live.
One important note: the documents don’t need to be drafted by a lawyer to be valid in most states, though legal guidance can help if your situation is complex.
Where to Store Your Plan
An advance care plan is useless if no one can find it during an emergency. The single most common mistake people make is completing the paperwork and then filing it away where nobody knows to look.
Start by giving copies to your healthcare proxy, your primary care doctor, close family members, and anyone else who might be involved in your care. If your local hospital is willing, ask them to keep a copy on file in case you’re admitted. When you go to the hospital for any reason, bring a copy with you.
For digital storage, several services will hold your documents and make them available on demand from anywhere. MedicAlert, MyDirectives by AD Vault, and the U.S. Advance Care Plan Registry all offer this kind of access. You can also store a scanned copy on your phone, computer, or in cloud storage. If you keep a paper original, store it somewhere safe but easy to find, and make sure others know where it is. Do not put the original in a safety deposit box, where it could be inaccessible during an emergency.
Does Advance Care Planning Actually Help?
The honest answer is that the evidence is more nuanced than most health websites suggest. A systematic review of randomized controlled trials published in BMJ Open found mixed results on whether advance care planning reduces hospitalizations or healthcare costs. Only a small share of studies, about 18%, showed significant reductions in healthcare use. The strongest evidence came from very specific settings: one study involved pre-surgical planning conversations led by anesthesiologists, and another focused on patients with serious psychiatric conditions, where compulsory hospital admissions dropped over a 15-month follow-up.
Where the benefit is clearest is less about statistics and more about alignment. Having a plan means your care team and family aren’t left guessing during the worst possible moment. Families who haven’t discussed these wishes often face agonizing disagreements in the ICU, and the emotional toll of making life-or-death decisions with no guidance from the patient can linger for years. The plan protects the people you love from carrying that weight alone.
When to Create One (and When to Update It)
Every adult over 18 benefits from having an advance care plan, not just people who are elderly or seriously ill. Accidents and sudden medical events don’t follow a schedule. That said, certain moments make the conversation especially timely: a new medical diagnosis, an upcoming surgery, retirement, or the death of someone close to you.
Your plan isn’t permanent. Review it every few years and after any major life change, such as a divorce, the death of your chosen proxy, or a new diagnosis. If your wishes change, update the documents, redistribute copies to everyone who has the old version, and make sure your medical records reflect the new plan.