Advance directives

The 20-minute paper that matters more than your will.

If you can only do one piece of end-of-life paperwork this month, do this. It costs nothing, it takes a single conversation, and it spares your family from making the worst decisions of their lives without knowing what you wanted.

An open leather-bound notebook with a fountain pen on a wooden desk, beside a small bowl of dried lavender and a cup of tea, lit by soft window light.

What an advance directive actually is.

Two pieces of paper, usually combined into one form:

  • The healthcare proxy. Names a person (and ideally a backup person) to make medical decisions for you if you cannot. Some states call this a healthcare power of attorney, healthcare agent, or surrogate. Same thing.
  • The living will. Your written wishes for specific treatments. Whether you want to be put on a ventilator. Whether you want a feeding tube if you can't eat. Whether you want CPR if your heart stops. Whether you want to donate organs.

Most state forms include both on a single page or two. Sign once, witness once, done.

The conversation comes before the paper.

Pick your proxy carefully. The right person is not always the closest person. The right person is someone who:

  • Will pick up the phone, even at 2am.
  • Will not freeze under pressure.
  • Can hear "we need to make a decision in the next four hours" and not panic.
  • Knows you well enough to guess what you would want, when the form didn't anticipate the situation.
  • Will not be a sibling who wants to fight with another sibling.

Have the conversation in person. Tell them: "I'd like you to be my healthcare proxy. Here's what that means. Here's what I'd want." Eat a meal afterwards. It will be the most useful uncomfortable hour of the year.

How to do it this weekend.

  1. Search "[your state] advance directive form". Almost every state Department of Health publishes a free PDF. Or download a free state-specific form from CaringInfo (a project of the National Hospice and Palliative Care Organization).
  2. Fill it in, including a backup proxy.
  3. Sign it in front of two adult witnesses who are not your proxy and not in your will. Some states (Missouri, North Carolina, others) also need a notary. The form will say.
  4. Give a copy to: your proxy, your backup proxy, your primary care doctor's office, your local hospital if you have one, and yourself (somewhere your family can find it, not a bank safe deposit box).
  5. If your state has a registry (Vermont, Idaho, Arizona, several others), upload it.

What this guide gets wrong.

We are not lawyers, and we are not your doctor. State law on advance directives changes every few years. Witnessing rules in particular have shifted post-2020. If anything in this guide differs from what your state form or hospital social worker tells you, follow them. Also: a directive does not cover financial decisions. For that you need a financial power of attorney, which is a different document.

Common questions about directives.

What's the difference between a living will and a healthcare proxy? +

The healthcare proxy (also called a healthcare power of attorney) names a person, your decision-maker, if you can't speak. The living will is a set of written instructions about specific treatments: ventilator, feeding tube, CPR. You almost always want both. The proxy handles the cases your living will didn't anticipate.

Do I need a lawyer to do this? +

No. State forms are valid when signed and witnessed correctly. Witness rules vary. Most states need two adult witnesses who are not your proxy or your doctor. A handful require a notary. Your state's Department of Health website will say.

Will hospitals actually honor it? +

Yes, when they have a copy in hand. The two failure modes are: (a) nobody knows you have one, and (b) it's in a safe at home and you're at a hospital across the state line. Give a copy to your proxy, your primary doctor, and ask them to upload it to your medical record. Some states have an online registry; ask if yours does.

Is a POLST or MOLST the same thing? +

No, although they often work together. A POLST (Physician Orders for Life-Sustaining Treatment) is a medical order signed by you and your doctor, used near the end of life, when an advance directive becomes too abstract. Most healthy adults don't need a POLST; they need an advance directive. People in the last year of life often need both.

Can I change my mind? +

Yes, anytime, as long as you have decision-making capacity. The simplest way is to sign a new directive, destroy the old one, and tell your proxy and doctor.