An advance directive is your voice when you can’t speak for yourself — it tells doctors what medical treatment you want (or don’t want) and who should make healthcare decisions on your behalf. Without one, your family may face agonizing choices with no guidance and potential legal battles.
Types of Advance Directives
Document
What It Does
Who Needs It
Living will
States your wishes for end-of-life medical treatment
Every adult 18+
Healthcare proxy (healthcare POA)
Names someone to make medical decisions for you
Every adult 18+
DNR order (Do Not Resuscitate)
Instructs medical staff not to perform CPR
Typically elderly or terminally ill
POLST / MOLST
Specific medical orders for seriously ill patients
Seriously ill or frail elderly
Mental health advance directive
States psychiatric treatment preferences
Anyone with mental health conditions
Living Will vs. Healthcare Proxy
Feature
Living Will
Healthcare Proxy
States your treatment wishes
✓
✗
Names a decision-maker
✗
✓
Covers specific scenarios
✓
Depends on agent’s judgment
Flexible for unforeseen situations
Limited
✓
Needs both?
Yes — they work together
Yes — they work together
A living will covers the “what.” A healthcare proxy covers the “who.” You need both.
Comfort care preferences, even if it hastens death
Specific treatments
Dialysis, blood transfusions, surgery
How to Choose a Healthcare Proxy
Your healthcare proxy (also called a healthcare agent or surrogate) is one of the most important people in your estate plan:
Criteria
Why It Matters
Trusts your judgment and values
They’ll carry out your wishes, not theirs
Can handle pressure
Medical decisions are emotionally difficult
Available and nearby (ideally)
May need to arrive at a hospital quickly
Willing to advocate for you
May need to push back against doctors or family
Over 18
Legal requirement
Not your doctor or healthcare provider
Conflict of interest (restricted in most states)
Name an alternate. If your primary proxy can’t serve, the backup steps in immediately.
How to Create an Advance Directive
Step
Action
Details
1
Download your state’s form
Free from your state’s health department or AARP
2
Decide your treatment preferences
Use the scenarios above as a guide
3
Choose a healthcare proxy + alternate
Discuss your wishes with them
4
Complete the form
Fill in all sections — vague answers cause problems
5
Sign and witness/notarize
Requirements vary by state (see below)
6
Distribute copies
Proxy, doctor, hospital, family, attorney
7
Review every few years
Update after health changes or change of proxy
State Requirements
Requirement
States
Two witnesses required
Most states
Notarization required
A few states (varies)
Both witnesses and notarization
Some states
Witnesses cannot be beneficiaries
Most states
Healthcare proxy form is separate from living will
About half the states
Combined form (both in one document)
About half the states
Tip: Use your state’s official form to avoid validity issues. Free forms are available from your state attorney general’s office, health department, or at CaringInfo.org.
Cost Comparison
Method
Cost
Best For
State-provided form (free)
$0
Everyone — do this at minimum
Online service (AARP, Five Wishes, LegalZoom)
$5–$150
Guided process, clear language
Estate planning attorney (as part of package)
$200–$500
Complex medical situations
Hospital social worker
$0
If you’re already hospitalized
POLST vs. Advance Directive
Feature
Advance Directive
POLST / MOLST
For everyone?
✓
Only seriously ill or frail
Created by you
✓
Created with your doctor
Medical orders (binding on EMS)
✗
✓
Covers future scenarios
✓
Current medical condition only
Portable (bright-colored form)
✗
✓ (posted on fridge, travels with patient)
Replaces advance directive
✗
✗ (supplements it)
Common Mistakes to Avoid
Mistake
Why It’s a Problem
Not having one at all
Family makes decisions blind — often leads to conflict
Being too vague
“No heroic measures” has no legal meaning — be specific
Not telling your proxy
They can’t carry out wishes they don’t know about
Not giving copies to your doctor
It must be in your medical record to be followed
Only keeping one copy
If it can’t be found, it can’t be used
Choosing a proxy who can’t handle it
Some people freeze under pressure — choose wisely
Never updating it
Your wishes may change after a health scare or new diagnosis
Where to Store Your Advance Directive
Location
Why
Your healthcare proxy
They’ll need it first
Your primary doctor’s office
Goes in your medical file
Your hospital (if you have a regular one)
On file for emergencies
Home (easily accessible)
Fridge or bedside — EMS often checks these
Your attorney
Part of your estate planning file
Digital copy (secure)
Email to proxy, store in cloud — backup only
State registry (if available)
Some states maintain advance directive registries
Bottom Line
An advance directive takes 30 minutes and $0 to complete — and it’s one of the most important things you can do for your family. Without one, your loved ones face impossible decisions with no guidance, and doctors default to maximum treatment, which may not be what you want. Download your state’s free form, fill it out, and give copies to your proxy and doctor today.