Advance Directives

Advance care planning is often mistaken for something only the elderly or terminally ill need to think about. In reality, it is a crucial process for any adult.

At its core, completing an advance directive is about giving your loved ones a profound gift. By clearly documenting your healthcare wishes and appointing someone to speak for you, you remove the heavy burden of guesswork from your family during a medical crisis.

The Two Core Documents

An "Advance Directive" is an umbrella term that usually encompasses two distinct legal documents. You can have one or both, though having both is highly recommended. A way to think about it is that the Living Will is like a roadmap for your healthcare decisions, and the Healthcare Proxy is like the person who will drive the care with those wishes.

The Living Will:

This document outlines your specific preferences for medical treatments at the end of life. At a bare minimum, it details what kind of interventions or life-sustaining measures you would want (or explicitly not want) to receive. Common examples include intubation, artificial nutrition and hydration, dialysis, pacemakers, CPR, and certain medications.

Beyond just medical checklists, a Living Will can—and should—include your framework for what constitutes a good quality of life. A pertinent example comes from Atul Gawande's book Being Mortal, where someone stated his baseline for a life worth living was simply being able to "eat chocolate ice cream and watch football on television." Providing this kind of deeply personal framework gives your proxy a much clearer lens through which to weigh the pros and cons of future medical interventions - or interventions when you cannot speak for yourself (ie:, while in surgery).

Medical Power of Attorney:

This document designates a trusted person, your "healthcare proxy" or "agent", to make healthcare decisions on your behalf if you become incapacitated and cannot speak for yourself. This document often needs to be signed by two witnesses or in the presence of a notary public.

This person must be at least 18 years old, be willing and able to do this, be willing to honor your preferences even if they are different from their own, and must not be a doctor or health care professional involved in your care.

Choosing Your Healthcare Proxy

Selecting the right person to be your proxy is one of the most important decisions in this process. The best person for the job isn't always your closest relative.

A good proxy should be someone who:

Can remain calm under immense pressure.
Is willing to ask doctors difficult questions, like what is the downside risk of a particular intervention, and advocate fiercely for you.
Will honor your wishes, even if those wishes conflict with their own personal beliefs or emotions.

It is imperative to have these difficult conversations with someone around your wishes for care to ensure that your proxy understands your wishes and will act in your best interests when you cannot speak for yourself.

DNR and POLST Forms

If you are seriously ill and do not want emergency interventions, you need actionable medical orders signed by a doctor:

DNR (Do Not Resuscitate): A very specific doctor's order instructing healthcare providers not to attempt CPR or chest compressions if your breathing or heartbeat stops.
POLST / MOLST Forms: (Physician/Medical Orders for Life-Sustaining Treatment). These are brightly colored, standardized medical orders designed for people who are already seriously ill or frail. They translate your general wishes into immediate, on-the-spot doctor's orders that paramedics and hospitals must follow in an emergency (such as whether to use a breathing tube or transport you to the ICU).

Difference from Living Will: A Living Will is a legal document that guides your future care. However, in an emergency, 911 responders cannot pause to read a legal document—they are legally required to perform life-saving measures by default, in the absence of a DNR or POLST form.

Medical vs. Financial Power of Attorney

A common point of confusion is the difference between a Medical Power of Attorney (MPOA) and a Durable Power of Attorney (DPOA). The simplest way to remember the difference is the body vs. the bank.

Medical Power of Attorney (Healthcare Proxy): This person is legally authorized to make only medical and healthcare decisions for you (choosing doctors, consenting to treatments). Because it is designed specifically for when you are incapacitated, it is inherently durable (meaning it stays in effect when you cannot speak for yourself).
Durable Power of Attorney (Financial): In everyday hospital and legal jargon, when someone says DPOA, they are usually referring to finances. This person handles your money, property, and legal affairs (like paying your mortgage or managing bank accounts to pay for a care facility).

Important: Unless explicitly combined into one master document by an attorney, your medical proxy cannot write checks, and your financial proxy cannot make medical decisions.

Funeral Arrangements

A very common mistake people make is placing their wishes for a memorial service solely in their Last Will and Testament. Because a Will is often not opened or read until weeks after the funeral has taken place, families are left to guess their loved one's wishes during an incredibly stressful time.

To prevent this, it is highly recommended to write down your after-death wishes, keep them securely attached to your Advance Directive copies, and talk about them with your loved ones (or at least tell them where they can find them).

Disposition of the Body: Would you prefer traditional burial, cremation, or a newer alternative like human composting or aquamation? Is there a specific funeral home or crematorium you would like to use?
The Service: Do you want a traditional funeral, a celebration of life, a quiet gathering, or no service at all? Who do you want to be involved? Would you want a specific person to deliver a eulogy?
Funding & Pre-Planning: Have you already purchased a burial plot or pre-paid for cremation services? If so, the exact details, contract numbers, and contact information for the funeral home must be easily accessible to your proxy.

Wishes for Your Final Days

Beyond the big medical decisions, there is a quieter set of wishes worth documenting — ones that shape how you experience your final days. These are often very meaningful to families, and deserve to be honored.

Where you want to die: Home, inpatient hospice, nursing facility, or hospital. If location matters to you, say so — often this can be honored when it's clear and known in advance.
Comfort care: Whether you want sedation for terminal agitation, and the degree to which you want to leverage pain medications to keep you comfortable.
Who you want present — and who you don't: Both are valid. If having a list of the people you would want to visit and certain people you'd want to feel comfortable waking you, you can make that known. If there are people you would not want to be present, you can make that known.
Environment: Music, lighting, spiritual rites, physical touch — or none of the above. These give your loved ones something concrete to draw from when curating the environment to sit vigil.

Want to understand what these moments look like? The guide to the dying process walks through the physical journey from months to final hours.

Where to Start

You do not necessarily need a lawyer to create an advance directive. Many accessible, legally binding resources exist to help you clarify your values and complete the paperwork.

State-Specific Forms: Advance directive laws vary by state. Both AARP and CaringInfo provide free, downloadable forms specific to your state.
Five Wishes: A widely popular, easy-to-understand advance directive document that covers medical, personal, emotional, and spiritual wishes. Legally valid in most states.
PREPARE for Your Care: An interactive, step-by-step online program with video guides to help you make medical decisions and talk with your family.
I Made the Arrangements: A website that helps you plan your funeral and memorial arrangements for free. There are also other tools on that platform to help you with your planning.

Important: Once your forms are complete, do not lock them in a safe. Give copies to your healthcare proxy, your doctors, and your local hospital so they are accessible when needed.

What If My Wishes Change?

It is completely normal for your values and healthcare preferences to evolve over time. You can update your advance directive at any time, as long as you are still capable of understanding and communicating your decisions.

Your Voice is the Final Authority: The most important thing to remember is that as long as you are able to speak for yourself, the choices you make in the moment will always override what is written in your document. The directive only takes over when you cannot communicate.
Start Fresh: If you want to make changes, do not just cross out sections or write in the margins of your old form. You will need to fill out and authorize a brand new advance directive.
Distribute and Destroy: Give the newly updated version to your healthcare proxy, your doctors, and your loved ones. Be sure to ask them to hand over any old copies they might have so you can safely destroy them. This prevents conflicting documents from causing confusion during an emergency.

Tip: A good rule of thumb is to review your advance directive whenever you experience one of the "5 D's":

Every new Decade,
After a Death of a loved one,
After a Divorce,
After a new Diagnosis,
After a significant Decline in health.