Advance directives are among the most loving gifts a family can put in place: they make sure a person's wishes are honored, and they spare loved ones from having to guess during a crisis. Yet many families put off setting them up because the terms sound intimidating.
They don't have to be. Here's what the main documents are and how they fit together. (Laws vary by state, so use your state's forms and consult an attorney for anything specific.)
The two main documents
'Advance directive' is the umbrella term for documents that give instructions about medical care if a person can't speak for themselves. The two most common are a living will and a health care proxy — and most people benefit from having both.
- A living will spells out what treatments someone would or wouldn't want (things like resuscitation, ventilators, or tube feeding) and under what conditions
- A durable power of attorney for health care (health care proxy) names who makes medical decisions when the person can't — an agent who can respond to situations no document could fully anticipate
POLST forms and the fine print
There's also the POLST (or MOLST/POST, depending on the state) — a portable medical order signed by a doctor, meant for people who are seriously ill or frail, that EMTs can act on immediately. Advance directives, by contrast, generally take effect once a physician determines the person can't make their own decisions. Good news on cost: state forms are usually free, and no state requires a lawyer to complete them — though you do need to follow your state's witnessing and notary rules, and Medicare covers voluntary advance-care-planning conversations at wellness visits.
- Talk through values and wishes together, and with the doctor.
- Choose a health care proxy plus one or two alternates, and tell them your wishes.
- Get your state's free forms (from your Area Agency on Aging, AARP, or CaringInfo).
- Complete and sign them following your state's witness/notary rules.
- Share copies with the proxy, doctors, and family; review them yearly.
Keep the signed living will, health care proxy, and any POLST or DNR order together in one labeled place, with the proxy's contact info and a note of who has copies. Record the date each version was signed.
Frequently asked questions
What's the difference between a living will and an advance directive?
'Advance directive' is the umbrella term for documents about future medical care. A living will is one type — it specifies which treatments a person would or wouldn't want if seriously ill and unable to communicate.
What's the difference between a living will and a power of attorney?
A living will states treatment preferences, while a health care power of attorney names a trusted person to make medical decisions. Most people benefit from having both, since one covers wishes and the other covers unforeseen situations.
Do I need a lawyer to make an advance directive?
No — no state requires an attorney to complete an advance directive or living will. You do need to follow your state's witnessing and notary rules, which vary, so use your state's official form.
What is a healthcare proxy or medical power of attorney?
It's the document that appoints a trusted person (an agent, proxy, or surrogate) to make health care decisions on someone's behalf when they can't communicate their own wishes.
Do I need both a living will and a healthcare power of attorney?
Ideally, yes. The living will records specific treatment wishes, while the health care power of attorney lets your chosen agent respond to situations the document didn't anticipate.