Advance Directives

Advance directives are legal documents that tell doctors and family members what medical care you want — and who gets to make decisions — if you can't speak for yourself. Everyone over 18 should have them. Not just the elderly. Not just the sick.

The three documents

The terminology varies by state, but advance directives generally consist of three distinct documents. You may need all three, or just one or two depending on your situation.

Living will

A living will (sometimes called a directive to physicians or healthcare declaration) is a written statement of your wishes for medical treatment at end of life. It addresses questions like:

• Do you want life-sustaining treatment if you're in a persistent vegetative state?
• Do you want a ventilator if there's no reasonable chance of recovery?
• Do you want CPR attempted?
• Do you want artificial nutrition and hydration?
• What are your wishes around pain management and comfort care?

A living will only takes effect when you are incapacitated and cannot communicate your wishes. It has no bearing on your care while you can speak for yourself.

Healthcare proxy (durable power of attorney for healthcare)

A healthcare proxy — also called a healthcare power of attorney or medical power of attorney — designates a specific person to make medical decisions on your behalf if you can't make them yourself.

This person, called your healthcare agent or proxy, can interpret your wishes in situations your living will doesn't specifically address. They can speak with doctors, review your records, and make real-time decisions. A good living will paired with a trusted, informed proxy is the most complete advance care plan you can have.

POLST form

A POLST (Physician Orders for Life-Sustaining Treatment) is different from the other two. It's a medical order, not just a statement of preferences — meaning it has immediate legal force with emergency responders and medical staff.

POLST forms are typically for people who are seriously ill, elderly, or in declining health. They translate your wishes into specific medical orders: whether to attempt resuscitation, whether to hospitalize, what level of intervention is wanted.

Unlike a living will, a POLST must be signed by a physician or other licensed provider. It travels with you — kept somewhere accessible at home and in your medical record.

How to execute these documents

Requirements vary by state — check your state's specific rules — but the general requirements are:

Living will and healthcare proxy

• Must be in writing and signed by you
• Usually requires two adult witnesses who are not your healthcare agent, not your heirs, and not your healthcare providers
• Some states require notarization instead of or in addition to witnesses
• You must be of sound mind at the time of signing

POLST

• Completed in conversation with your doctor or care team
• Signed by a licensed healthcare provider (physician, NP, or PA depending on state)
• Also signed by you or your legal representative

Where to keep them

Advance directives are useless if no one can find them when they're needed. Keep copies in all of these places:

• With your primary care physician — ask them to add it to your file
• With your healthcare proxy
• In your home — somewhere accessible, not locked in a safe
• In your hospital's patient portal or health record if your state has a registry
• With your estate documents alongside your will

For POLST forms specifically: keep it on the refrigerator or near the front door. Emergency responders are trained to look there.

How to get them

You do not need an attorney to create a living will or healthcare proxy. Your state's form is legally valid and free.

• CaringInfo.org (from the National Hospice and Palliative Care Organization) provides free, state-specific forms for all 50 states
• Your state health department website
• Your hospital or doctor's office — most can provide forms
• An estate planning attorney, if you want guidance or have complex wishes

Update them when things change

Revisit your advance directives after any major change: a new diagnosis, a change in your views about life-sustaining treatment, a change in your relationship with your proxy, or a move to a new state. Some states require re-execution after a certain number of years — check your state's rules.

The most important thing is to have a conversation with your proxy and your family. A document only goes so far. The people who love you need to understand what you actually want.