Advance directive template: how to document your end-of-life wishes

An advance directive documents your medical wishes so that doctors and your family know exactly what you want if you become unable to speak for yourself. It is one of the most important documents you can create — and one of the most commonly postponed.

This guide walks through what an advance directive needs to cover, how to fill one out section by section, where to get your state's form, and what to do with the document once it is complete.

What an advance directive must cover

A complete advance directive has two core components:

1. A living will (treatment directives): Your written instructions about specific medical treatments you want — or do not want — in defined circumstances. This covers decisions like CPR, mechanical ventilation, feeding tubes, and dialysis.

2. A healthcare proxy (durable power of attorney for healthcare): The designation of a trusted person to make medical decisions on your behalf if you cannot make them yourself. This person is sometimes called your healthcare agent, healthcare proxy, or patient advocate depending on the state.

Most states offer a combined form that covers both components. Some states have separate forms for each. A few states use different terminology — "patient advocate designation," "medical power of attorney," or "directive to physicians" — but they serve the same functions.

For a plain-language explanation of the terminology and how these documents differ, see Advance directive vs. living will: what is the difference?

Section-by-section: what to write

CPR (cardiopulmonary resuscitation)

CPR is the set of interventions — chest compressions, electric shocks, breathing tubes — used when the heart or breathing stops. It is most effective when used in otherwise healthy people following sudden cardiac arrest.

Your advance directive should state clearly:

• Whether you want CPR attempted in the event your heart stops
• Whether your answer changes if you are in a terminal condition or have little chance of meaningful recovery

If you do not want CPR attempted under any circumstances, a separate document called a DNR (do-not-resuscitate order) or POLST (Physician Orders for Life-Sustaining Treatment) may be needed in addition to your advance directive — these are physician-signed orders, not simply patient statements. See What is a DNR? and What is a POLST? for how these documents work alongside an advance directive.

Mechanical ventilation

Mechanical ventilation uses a machine to breathe for you when you cannot breathe on your own. State your preferences for:

• Short-term use (for example, after surgery or a sudden injury with reasonable recovery prospects)
• Long-term or indefinite use when there is no expectation of recovery
• A time-limited trial ("use for up to 14 days, then reassess") if you are uncertain

Feeding tubes and artificial nutrition

A feeding tube delivers nutrition and fluids through a tube when you cannot eat or swallow. Address:

• Whether you want a feeding tube if you are in a permanent vegetative state
• Whether you want one if you have late-stage dementia
• Whether you want a time-limited trial before a decision is made

Many people want some forms of life-sustaining treatment but draw the line at permanent unconsciousness or severe dementia. Write what the line is for you specifically.

Dialysis

Dialysis replaces kidney function when the kidneys fail. It requires regular sessions (often three times weekly) and can be physically demanding. Consider whether you want:

• Dialysis begun as a bridge to recovery
• Dialysis maintained indefinitely if you are otherwise healthy
• Dialysis stopped or not started if you have a terminal condition

Pain management and comfort care

Even if you decline life-prolonging treatments, you are entitled to full comfort care — management of pain, anxiety, and symptoms. Your advance directive should explicitly state that you want adequate pain and comfort management even if it may secondarily shorten life. This is always legal and always your right.

Organ and tissue donation

State whether you wish to donate organs and/or tissues after death, and whether there are any organs you wish to exclude. Note that most states maintain a separate organ donor registry — your advance directive alone may not be sufficient. Check your state's donor registry and ensure your driver's license reflects your wishes.

Pregnancy clause

Many states have specific laws about whether an advance directive can be honored if the person is pregnant. If you are or could become pregnant, some states require that life-sustaining treatment be continued regardless of your stated wishes until delivery. Review your state's law and, if applicable, state your wishes explicitly in your document.

Dementia-specific instructions

Alzheimer's disease and other forms of dementia present a challenge that generic advance directives often fail to address: a person may be cognitively impaired but physically stable. Standard living will language — triggered only when death is "imminent" or the condition is "terminal" — may not apply.

If dementia is a concern, consider adding specific dementia instructions that address:

• Whether you want hospitalization and intensive intervention for infections and other complications in late-stage dementia
• Whether you want a feeding tube if you stop being able to eat
• What level of cognitive function is meaningful to you

Adding a values statement

Beyond specific treatment choices, an advance directive is stronger and more useful to your healthcare proxy when it includes a values statement — a plain description of what makes life meaningful to you.

Examples of what to write:

• "What matters most to me is being able to recognize and communicate with the people I love."
• "I would not want to be kept alive if I had no realistic hope of ever leaving a care facility."
• "I place high value on quality of life over length of life. I do not fear death, and I do not want extraordinary measures to delay it when my condition is irreversible."

A values statement helps your healthcare proxy make decisions that are not explicitly covered by your written instructions. Medical situations are unpredictable, and even a thorough living will cannot anticipate every scenario. A clear statement of your values fills the gaps.

Designating your healthcare proxy

Choose someone who:

• Knows you well and understands your values
• Can handle medical conversations and make difficult decisions under pressure
• Is geographically accessible (or able to be reached quickly)
• Will advocate for what you want, not what they want for you

Talk to your proxy before naming them. Walk through specific scenarios. The conversation is uncomfortable — but it is far less uncomfortable than the decisions your proxy will face without guidance.

Name a backup (alternate) proxy in case your primary proxy is unavailable. In some states, you can name co-agents who make decisions jointly; in others, only one agent may act at a time.

State-specific forms vs. your own document

Every state has its own advance directive form. Using your state's official form is generally the best choice:

• Healthcare providers and hospitals are familiar with them
• They are pre-formatted to meet witness and notarization requirements
• They are more likely to be accepted without question in an emergency

Where to find your state's free form:

• State health department website — search "[your state] advance directive form"
• CaringInfo.org (caringinfo.org) — free forms for all 50 states, maintained by the National Hospice and Palliative Care Organization
• Five Wishes (fivewishes.org) — a plain-language document that is legally valid in most states and available for a small fee

Five Wishes is worth noting: it combines the living will and healthcare proxy into one user-friendly document and includes the values statement, religious preferences, and personal care instructions in a format that is easier for most people to complete than a legal form.

Witness and notarization requirements by state

Most states require an advance directive to be signed in front of witnesses. Some require notarization. Requirements vary significantly — here is a general summary:

| Requirement | States | |---|---| | Two witnesses, no notary | Most states (including California, Florida, Texas, Illinois) | | Notary required, no witnesses | Colorado, Mississippi, Missouri, New Mexico, North Dakota | | Both witnesses AND notary | Louisiana, Pennsylvania, Tennessee, West Virginia | | One witness only | North Carolina, Virginia |

Key witness restrictions that apply in nearly all states:

• Your healthcare proxy cannot be a witness
• A treating physician or healthcare facility employee generally cannot be a witness
• Heirs and beneficiaries under your will are often excluded

Check your state's specific requirements before signing. An advance directive signed without the required witnesses or notarization may be unenforceable.

Digital storage and who gets a copy

An advance directive that no one can find is no advance directive at all. After completing and signing the document:

Give copies to:

• Your primary care physician (ask that it be added to your medical record)
• Any specialists who treat you regularly
• Your hospital (if you are admitted, bring a copy)
• Your healthcare proxy
• Your family members who are likely to be present in a medical emergency

Store the original somewhere accessible:

• A fireproof home safe with instructions on where to find it
• A document vault like the one in Passings, where your proxy can access it when needed
• Some states have advance directive registries — Arizona, California, Washington, and others — where a copy is filed and can be accessed by healthcare providers

Do not store it in a safe deposit box — banks may not open the box promptly in an emergency.

How often to update your advance directive

Review your advance directive:

• Every three to five years as a routine check
• After a significant health change or new diagnosis
• After a major life change (marriage, divorce, the death of your named proxy)
• Any time your values or wishes change

If you update your advance directive, destroy old copies wherever possible to avoid confusion. Notify your physician, healthcare proxy, and anyone else who holds a copy.

What to do if your wishes change

You have the right to revoke or change your advance directive at any time while you have decision-making capacity. To revoke it, provide written notice to your healthcare provider, your proxy, and anyone else holding a copy. Destroy the old document.

If you are hospitalized and wish to change your instructions, tell your nurse or physician directly. Your verbal revocation in the presence of a healthcare provider is generally sufficient — you do not need a new signed document to override an existing one in an acute medical situation.

Frequently asked questions

Does an advance directive expire?

In most states, an advance directive does not expire automatically. It remains in effect until you revoke it or update it. However, some states require renewal after a set period (Montana requires renewal every three years, for example). Check your state's law and review your document periodically regardless.

What if I move to another state?

Most states honor advance directives from other states as long as the document was valid where it was signed. However, some states have specific requirements that your document may not meet. If you move, complete a new advance directive in your new state to be safe.

Can my family override my advance directive?

No. A properly executed advance directive is legally binding. Family members cannot override it. This is one of the most important functions of the document — it protects your wishes even when family members disagree. However, if a family member disputes the document or challenges your capacity at the time you signed it, a healthcare provider may pause to seek legal guidance. This is rare but possible.

Do I need an attorney to create an advance directive?

No. The state forms are designed to be completed without an attorney. However, an attorney can help if you have complex wishes, a challenging family situation, or specific language you want to add beyond the standard form. An estate planning attorney familiar with your state's laws is the best resource if you have questions.

What is the difference between an advance directive and a POLST?

An advance directive is a legal document you create yourself — it expresses your preferences for treatment. A POLST (Physician Orders for Life-Sustaining Treatment) is a medical order signed by a physician that translates your wishes into actionable clinical instructions. The POLST is for people with serious illness or advanced age where death within a year is a realistic possibility. For most people, an advance directive is the right starting document. If you are seriously ill, your physician may recommend completing both. See What is a POLST? for more.

What Passings Can Help With

Passings helps you organize every end-of-life document — including your advance directive — in one secure place where your family and healthcare proxy can access it when they need it most.

The Passings document vault stores sensitive documents with strong encryption. You can upload your completed advance directive, add notes about who holds copies, and grant access to the people who should have it. Passings also includes a guided checklist that walks you through advance care planning step by step, including the other legal documents that work alongside an advance directive.

When you are ready to find an estate planning attorney or advance care planning specialist who can review your documents, the Passings marketplace can help you connect with a local provider.

Disclaimer — For informational purposes only

This article is compiled from publicly available resources and is provided solely for general informational purposes. It does not constitute and should not be relied upon as legal, financial, tax, insurance, medical, psychological, or other professional advice. Passings is a planning and organizational platform, not a licensed advisory service, and no attorney-client, financial advisor-client, or other professional relationship is created by reading this content.

Laws, regulations, financial products, and professional standards vary by state and change over time. Passings makes no representations or warranties — express or implied — regarding the accuracy, completeness, timeliness, or suitability of any information contained herein. To the fullest extent permitted by applicable law, Passings disclaims all liability for any loss, damage, or harm arising from your use of or reliance on this content. Always consult a qualified, licensed professional — including an attorney, financial advisor, CPA, or licensed counselor — before making decisions specific to your situation.

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