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Advance Directive
(Living wills)

Overview

Living wills and other advance directives include written, legal instructions that state the treatment you want for medical conditions when you're unable to make decisions for yourself. Advance directives guide choices for healthcare professionals and caregivers in certain situations. For example, a medical team may use advance directives when you're unable to talk and are terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.

Advance directives aren't only for older adults. You can have unexpected accidents, illnesses or end-of-life situations happen at any age. So it's important for all adults to prepare these papers.

By planning ahead, you can get the medical care you want and avoid unnecessary suffering. You also can relieve caregivers of decision-making burdens during times of crisis or grief. And you help lessen confusion or disagreement about the choices you would want people to make on your behalf.

What is an advance directive?

An advance directive is a legal document. It tells your doctor and family what kind of medical care you want to have if you can’t tell them yourself.

This could happen if you:

Are in a coma.

Are seriously injured.

Are terminally ill.

Have severe dementia.

If you are admitted to the hospital, the hospital staff will probably talk to you about advance directives.

Path to improved well being

A good advance directive describes the kind of treatment you would want, depending on how sick you are. It could describe what kind of care you want if you have an illness that you are unlikely to recover from. It could also describe the care you want if you are permanently unconscious. Advance directives usually tell your doctor that you don’t want certain kinds of treatment. They can also say that you want a certain treatment no matter how ill you are.

Types of advance directives

Advance directives could include:

Living will

A living will is a written, legal paper, called a document, that includes details about the medical treatments you would and would not want to be used to keep you alive. It's used when you are unable to decide yourself. It also includes your choices for other medical decisions, such as pain management or organ donation.

In deciding your wishes, think about your values. For example, think about how important it is to you to be independent and self-sufficient. Think about what situations might make you feel like your life is not worth living. Would you want treatment to extend your life in any situation or in all situations? Would you want treatment only if a cure is possible?

You should list many possible end-of-life care decisions in your living will. Talk to your healthcare professional about any questions you may have about the following medical decisions:

Cardiopulmonary resuscitation (CPR). CPR restarts the heart when it has stopped beating. Decide if and when you would want to be revived by CPR or by a device that sends an electric shock to shock the heart.

Pacemakers and implantable cardioverter defibrillators (ICDs). A pacemaker keeps your heart beating steadily, while an ICD shocks your heart if it beats irregularly. If you have one of these devices, decide when you would want it to be turned off.

Mechanical ventilation. A machine that helps you breathe is called a mechanical ventilator. It takes over your breathing if you're unable to breathe on your own. Think about if, when and for how long you would want a medical team to place you on a machine to help you breathe.

Tube feeding. Tube feeding gives nutrients and fluids to the body through a tube inserted in a vein or in the stomach. Decide if, when and for how long you would want a medical team to feed you in this way.

Dialysis. This process removes waste from the blood and manages fluid levels if the kidneys no longer work. Decide if, when and for how long you would want to receive this treatment.

Antibiotics or antiviral medications. Healthcare professionals can use these medicines to treat many infections. Think about if you were near the end of life. Would you want a medical team to treat infections with many medicines, or would you rather let infections run their course?

Comfort care, also called palliative care. Comfort care includes many treatments that a medical team may use to keep you comfortable and manage pain while following your other treatment wishes. Treatment wishes may include choosing to die at home, getting pain medicines or being fed ice chips to soothe mouth dryness. It also may include avoiding invasive tests or treatments.

Organ and tissue donations. You can note if you plan to donate organs or tissues in your living will. If the medical team removes the organs for donation, they will keep you on treatment that will keep you alive, called life-sustaining treatment, for a brief time until the team has removed the organs. To avoid any confusion from your healthcare agent, you may want to state in your living will that you understand the need for this short-term treatment.

Donating your body. You can state if you want to donate your body to scientific study. Call a local medical school, university or donation program for information on how to register for a planned donation for research.

Durable power of attorney for health care

A medical or healthcare power of attorney is a type of advance directive in which you name a person to make healthcare decisions for you when you are unable to do so. In some states this directive also may be called a durable power of attorney for healthcare or a healthcare proxy.

Depending on where you live, the person you choose to make healthcare decisions on your behalf may be called one of the following:

Healthcare agent.

Healthcare proxy.

Healthcare surrogate.

Healthcare representative.

Healthcare attorney-in-fact.

Patient advocate.

Choosing a person to act as your healthcare agent is important. Even if you have other legal papers about your care, you can't anticipate all situations ahead of time, such as emergencies and illnesses. And in some situations, someone will need to decide about your likely care wishes.

Aim to choose a person who:

Meets your state's requirements for a healthcare agent.

Is not your healthcare professional or a part of your medical care team.

Is willing and able to discuss medical care and end-of-life issues with you.

Can make decisions that follow your wishes and values.

Can speak up for you if there are disagreements about your care.

The person you name may be a spouse, other family member, friend or member of a faith community. You also may choose one or more other people in case the person you chose is unable to fulfill the role.

Physician orders for life-sustaining treatment (POLST)

In some states, advance healthcare planning includes a document called physician orders for life-sustaining treatment (POLST). This document also may be called provider orders for life-sustaining treatment (POLST) or medical orders for life-sustaining treatment (MOLST).

A POLST is meant for people who are diagnosed with a serious illness. This form doesn't replace your other directives. Instead, it serves as healthcare professional-ordered instructions — not unlike a prescription. A POLST ensures that, in case of an emergency, you get the treatment you prefer. Your healthcare professional will fill out the form. To fill out the form, your healthcare professional will use the information in your advance directives, the talks you have with your healthcare professional about the likely course of your illness and your treatment preferences.

A POLST stays with you. If you are in a hospital or nursing home, staff post the POLST near your bed. If you are living at home or in a hospice care facility, staff clearly place the POLST where emergency staff or other medical team members can easily find it.

Forms vary by state, but a POLST lets your healthcare professional include details about your care. These details can include what treatments a medical team should not use, under what conditions a medical team can use some treatments, how long a medical team may use some treatments and when the medical team should stop treatments.

Issues covered in a POLST may include:

Resuscitation.

Mechanical ventilation.

Tube feeding.

Use of antibiotics.

Requests not to transfer to an emergency room.

Requests not to be admitted to the hospital.

Pain management.

A POLST also states what advance directives you have written and who serves as your healthcare power of attorney. Like advance directives, you can cancel or update POLSTs.

Do not resuscitate (DNR) order

A do-not-resuscitate (DNR) order can also be part of an advance directive. Hospital staff try to help any patient whose heart has stopped or who has stopped breathing. They do this with cardiopulmonary resuscitation (CPR). A DNR order is a request not to have CPR if your heart stops or if you stop breathing. You can use an advance directive form or tell your doctor that you don’t want to be resuscitated. Your doctor will put the DNR order in your medical chart. Doctors and hospitals in all states accept DNR orders. They do not have to be part of a living will or other advance directive.

Other possible end-of-life issues that may be covered in an advance directive include:

Ventilation – if, and for how long, you want a machine to take over your breathing.

Tube feeding – if, and for how long, you want to be fed through a tube in your stomach or through an IV.

Palliative care (comfort care) – keeps you comfortable and manages pain. This could include receiving pain medicine or dying at home.

Organ donation – specifying if you want to donate your organs, tissues, or body for other patients or for research.

Do not intubate (DNI) order

A Do Not Intubate (DNI) Order is a medical order written by a doctor indicating that intubation and mechanical ventilation should not be performed if a patient experiences respiratory failure. This order is intended to prevent unwanted or unnecessary invasive respiratory support.

A DNI order is often used in conjunction with a Do Not Resuscitate (DNR) order, but it specifically addresses the use of breathing tubes and ventilators. As a result, some healthcare systems use the term Do Not Ventilate (DNV) interchangeably with DNI.

The decision to create a DNI order typically results from discussions between the doctor and patient (or patient’s Medical Power of Attorney). This order can be revoked at any time by the patient if they are mentally competent or by their Medical Power of Attorney.

Do not hospitalize (DNH) order

A Do Not Hospitalize (DNH) Order is a medical order that instructs healthcare providers not to transfer a patient to a hospital for treatment, even if their condition worsens. This order is typically used for individuals in long-term care facilities or receiving end-of-life care at home who prefer to avoid hospital-based interventions.

A DNH order does not mean the patient will receive no care. Instead, it indicates that care will be provided in their current setting, focusing on comfort and symptom management rather than curative treatments that would require hospitalization.

Out-of-hospital DNR order

An Out-of-Hospital Do Not Resuscitate (OOH-DNR) Order is a medical order that instructs emergency medical services (EMS) and other healthcare providers not to attempt cardiopulmonary resuscitation (CPR) on a person outside of a hospital setting. Also known as a Prehospital DNR or EMS-DNR, this order ensures a person’s wishes regarding resuscitation are respected in community settings.

An OOH-DNR requires a physician’s signature and may involve special identifiers like bracelets or necklaces. It can be part of a broader Advance Directive or POLST form. While it prevents CPR, other forms of care and comfort measures are still provided.

Implementation varies by jurisdiction, so consult healthcare providers or legal professionals for specific guidance.

Should I have an advance directive?

Every adult should have an advance directive in which you explain the type of health care you do or do not want when you can’t make your own decisions. You should also appoint someone who can speak for you to make sure your wishes are carried out.

Creating an advance directive is a good idea. It makes your preferences about medical care known before you’re faced with a serious injury or illness. This will spare your loved ones the stress of making decisions about your care while you are sick. Any person 18 years of age or older can prepare an advance directive.

People who are seriously or terminally ill are more likely to have an advance directive. For example, someone who has terminal cancer might write that they do not want to be put on a respirator if they stop breathing. This action can reduce their suffering. It can increase their peace of mind and give them more control over their death.

Even if you are in good health, you might want to consider writing an advance directive. An accident or serious illness can happen suddenly. If you already have a signed advance directive, your wishes are more likely to be followed.

You may also want to document your wishes about organ and tissue donation and brain donation. As well, learning about care options such as palliative care and hospice care can help you plan ahead.

Will an advance directive guarantee your wishes are followed?

An advance directive is legally recognized but not legally binding. This means that your health care provider and proxy will do their best to respect your advance directives, but there may be circumstances in which they cannot follow your wishes exactly. For example, you may be in a complex medical situation where it is unclear what you would want. This is another key reason why having conversations about your preferences is so important. Talking with your loved ones ahead of time may help them better navigate unanticipated issues.

There is the possibility that a health care provider refuses to follow your advance directives. This might happen if the decision goes against:

The health care provider’s conscience

The health care institution’s policy

Accepted health care standards

In these situations, the health care provider must inform your health care proxy immediately and consider transferring your care to another provider.

What happens if you do not have an advance directive?

If you do not have an advance directive and you are unable to make decisions on your own, the state laws where you live will determine who may make medical decisions on your behalf. This is typically your spouse, your parents if they are available, or your children if they are adults. If you are unmarried and have not named your partner as your proxy, it’s possible they could be excluded from decision-making. If you have no family members, some states allow a close friend who is familiar with your values to help. Or they may assign a physician to represent your best interests. To find out the laws in your state, contact your state legal aid office or state bar association.

How can I write an advance directive?

Advance directives need to be in writing. Each state has different forms and requirements for filling out legal documents. Depending on where you live, you may need to have the form signed by a witness or notarized. You can ask a lawyer to help you with the process, but you don't generally need a lawyer.

You can find links to state-specific forms on the websites of many organizations such as the American Bar Association, AARP, and the National Hospice and Palliative Care Organization.

Look over your advance directives with your healthcare professional and your healthcare agent to be sure you have filled out forms correctly.

When you have finished your documents:

Keep the original advance directives in a safe place that's easy to reach.

Give a copy of your advance directives to your healthcare professional. Make sure they know about your DNR or DNI orders and your healthcare power of attorney.

Give a copy of your advance directives to your healthcare agent and any other agents.

Keep a record of who has your advance directives.

Talk to family members and other important people in your life about your advance directives and your healthcare wishes. By talking to your family members now, you help ensure that they clearly understand your wishes. Having a clear understanding of your choices can help your family members avoid conflict and feelings of guilt.

Carry a wallet-sized card that notes you have advance directives and names your healthcare agent. The card should also state where a copy of your directives can be found.

Keep a copy of your advance directives with you when you are traveling.

How can you get started with advance care planning?

To get started with advance care planning, consider the following steps:

Reflect on your values and wishes. This can help you think through what matters most at the end of life and guide your decisions about future care and medical treatment.

Talk with your doctor about advance directives. Advance care planning is covered by Medicare as part of your annual wellness visit. If you have private health insurance, check with your insurance provider. Talking to a health care provider can help you learn about your current health and the kinds of decisions that are likely to come up. For example, you might ask about the decisions you may face if your high blood pressure leads to a stroke.

Choose someone you trust to make medical decisions for you. Whether it’s a family member, a loved one, or your lawyer, it’s important to choose someone you trust as your health care proxy. Once you’ve decided, discuss your values and preferences with them. If you’re not ready to discuss specific treatments or care decisions yet, try talking about your general preferences. You can also try other ways to share your wishes, such as writing a letter or watching a video on the topic together.

Complete your advance directive forms. To make your care and treatment decisions official, you can complete a living will. Similarly, once you decide on your health care proxy, you can make it official by completing a durable power of attorney for health care.

Share your forms with your health care proxy, doctors, and loved ones. After you’ve completed your advance directives, make copies and store them in a safe place. Give copies to your health care proxy, health care providers, and lawyer. Some states have registries that can store your advance directive for quick access by health care providers and your proxy.

Keep the conversation going. Continue to talk about your wishes and update your forms at least once each year or after major life changes. If you update your forms, file and keep your previous versions. Note the date the older copy was replaced by a new one. If you use a registry, make sure the latest version is on record.

Everyone approaches the process differently. Remember to be flexible and take it one step at a time. Start small. For example, try simply talking with your loved ones about what you appreciate and enjoy most about life. Your values, treatment preferences, and even the people you involve in your plan may change over time. The most important part is to start the conversation.

Things to consider

Can I change my advance directive?

You can change your directives at any time. If you want to make changes, you must fill out a new form. Give new copies to your healthcare professional and others, and get rid of all old copies. Specific requirements for changing directives may vary by state.

You should talk with your primary healthcare professional about any changes. Make sure a new directive replaces an old directive in your medical file. New directives also must be added to medical charts in a hospital or nursing home. Also, talk to your healthcare agent, family and friends about changes you have made.

Think about checking your directives and filling out new ones in the following situations:

New diagnosis. A diagnosis of a disease that is terminal or that majorly changes your life may lead you to make changes in your living will. Talk with your healthcare professional about the kind of treatment and care decisions that might be made during the expected course of the disease.

Change of marital status. When you marry, divorce, become separated, or become a widow or widower, you may need to choose a new healthcare agent.

About every 10 years. Over time your thoughts about end-of-life care may change. Check your directives from time to time to be sure they reflect your current values and wishes.

Questions to ask your doctor

I’m not sick. Do I need an advance directive?

What kinds of things should I include in my advance directive?

How do I go about getting a DNR order?

Do I have to pay a lawyer to draw up an advance directive?

What happens if I change my mind on the kind of care I want to receive?

How to find advance directive forms

You can establish your advance directives for little or no cost. Many states have their own forms that you can access and complete for free. Here are some ways you might find free advance directive forms in your state:

Contact your State Attorney General’s Office.

Contact your local Area Agency on Aging. You can find your area agency phone number by visiting the Eldercare Locator or by calling 800-677-1116.

Download your state’s form online from one of these national organizations: AARP, American Bar Association, or National Hospice and Palliative Care Organization.

If you are a veteran, contact your local Veteran’s Affairs (VA) office. The VA offers an advance directive specifically for veterans.

Some people spend a lot of time in more than one state. If that's your situation, consider preparing advance directives using the form for each state, and keep a copy in each place, too.
Do you need a lawyer to create advance directives?

Not necessarily. A lawyer can help but is not required to create your advance directives. However, if you have a lawyer, you should give them a copy of your advance directive. If you need help with planning, contact your local Area Agency on Aging. Other possible sources of legal assistance and referral include state legal aid offices, state bar associations, and local nonprofit agencies, foundations, and social service agencies.

There are also organizations that enable you to create, download, and print your forms online, but they may charge fees. Before you pay, remember there are several ways to get your forms for free. Some free online resources include:

PREPARE for Your Care: An interactive online program that was funded in part by NIA. It is available in English and Spanish.

The Conversation Project: A series of online conversation guides and advance care documents available in English, Spanish, and Chinese. The Conversation Project is a public engagement initiative led by the Institute for Healthcare Improvement.

For more information about advance directives

Administration for Community Living
202-401-4634
www.acl.gov
Department of Veterans Affairs
877-222-8387
www.va.gov/geriatrics
OrganDonor.gov
Health Resources & Services Administration
www.organdonor.gov
American Bar Association
800-285-2221
www.americanbar.org
CaringInfo
National Hospice and Palliative Care Organization
800-658-8898
caringinfo@nhpco.org
www.caringinfo.org
The Conversation Project
866-787-0831
theconversationproject.org
National POLST
202-780-8352
info@polst.org
www.polst.org
PREPARE for Your Care
info@prepareforyourcare.org
prepareforyourcare.org

Find Advance Directives Forms By State

States have specific forms for these documents so health care professionals can easily recognize the document’s purpose. To make things a little confusing, states use various terms to describe their advance directive forms.

When planning for your future medical care, prepare your advance directives to be sure your loved ones make health choices according to your wishes. Select your state below to find free advance directive forms for where you live.

You’ll find instructions on how to fill out the forms at each link.

Choose Your State