How to write an advance directive: a plain-English guide

An advance directive is a legal document that records your healthcare wishes so that doctors and family members know exactly what to do if you become unable to communicate. Writing one is one of the most protective things you can do for your family — and for yourself.

This guide explains every type of advance directive, how each one works, and how to complete them without a lawyer.

What an advance directive actually does

Without a written advance directive, medical teams must turn to your family for decisions. This puts enormous emotional weight on people who are already in distress — and family members often disagree.

An advance directive removes the guesswork. It gives doctors a clear legal record of your preferences, and it gives your family permission to honor what you actually wanted rather than what they hope you might have wanted.

The four types of advance directive

Living will

A living will records your specific medical preferences — the treatments you want, and those you don't — in situations where you cannot communicate. It typically covers:

• Cardiopulmonary resuscitation (CPR)
• Mechanical ventilation
• Artificial nutrition and hydration (feeding tubes)
• Dialysis
• Comfort care and pain management preferences

A living will is not a one-size document. You can be as specific or as general as you choose. You might state that you want all life-sustaining treatment attempted, or you might specify that you want only comfort care if you are in a terminal condition with no reasonable chance of recovery.

Healthcare proxy (also called healthcare power of attorney or medical POA)

A healthcare proxy designates a specific person — your "healthcare agent" — to make medical decisions on your behalf if you cannot. This person does not replace a living will; they work alongside it. When a situation arises that your living will doesn't cover, your agent can make the call.

Choose someone who:

• Knows your values and would honor them, even under pressure
• Can communicate clearly and calmly with medical staff
• Lives close enough to be present quickly, or is willing to travel

Make sure the person you choose agrees to take on this role before you name them.

Do-Not-Resuscitate (DNR) order

A DNR is a specific medical order — signed by a physician — instructing emergency responders not to perform CPR if your heart stops. Unlike a living will, a DNR must be signed by a doctor to be legally enforceable in most states. It is typically completed in coordination with your physician when you have a serious illness or when you are preparing for end-of-life care.

A DNR is not the same as refusing all treatment. It applies only to CPR.

POLST (Physician Orders for Life-Sustaining Treatment)

A POLST (also called MOLST, MOST, or POLST in different states) is a portable medical order form for people with serious illness or frailty. Unlike a living will — which is a personal document — a POLST is completed and signed by a physician and travels with you from setting to setting (home, hospital, nursing facility).

POLST forms are typically completed by people who are elderly, seriously ill, or who have a limited life expectancy. If you are otherwise healthy, a living will and healthcare proxy are usually sufficient.

How to complete an advance directive

Step 1: Obtain your state's specific form

Advance directives are governed by state law, and each state has its own form requirements. Using your state's official form ensures the document will be recognized by healthcare providers in your state. You can obtain these from:

• Your state's health department website
• Your doctor's office or hospital
• The National Healthcare Decisions Day website (nhdd.org)

Step 2: Think through your values first

Before you fill in any boxes, consider what "quality of life" means to you. Ask yourself:

• Are there conditions under which you would not want life-sustaining treatment continued?
• What matters most to you: length of life, or quality of experience?
• How do you feel about pain management, even if it may hasten death?

There are no right answers. The goal is to record your preferences, not a generic template.

Step 3: Complete and sign the form

Most states require your advance directive to be:

• Signed by you while you have mental capacity
• Witnessed by two adults who are not your healthcare agent, not a beneficiary in your will, and not your healthcare provider

Some states also require notarization. Check your state's specific requirements.

Step 4: Distribute copies

Your advance directive only works if the right people have it. Give copies to:

• Your designated healthcare agent
• Your primary care physician (ask them to add it to your medical record)
• Any specialists involved in your care
• Close family members you want to be aware of your wishes

Keep the original somewhere accessible at home — not locked in a safe deposit box where it cannot be found quickly.

Step 5: Register it if your state has a registry

Many states have advance directive registries that allow healthcare providers to access your document in an emergency. Registration is typically free. Search "[your state] advance directive registry" to find yours.

Updating your advance directive

An advance directive remains valid until you revoke it. You should review it:

• After a significant change in health status
• After a major life event (divorce, death of your designated agent)
• Every five to ten years, even if nothing has changed

To revoke an advance directive, you can destroy all copies, sign a written revocation, or simply create a new one with a more recent date.

Frequently asked questions

Do I need a lawyer to write an advance directive?

No. Most states provide official advance directive forms that you can complete yourself, as long as you sign them correctly with the required witnesses. A lawyer can help if your situation is complex, but legal assistance is not required.

What happens if I don't have an advance directive?

If you become incapacitated without an advance directive, a court may need to appoint a guardian to make decisions on your behalf — a process that can be slow, expensive, and emotionally draining for your family. In the meantime, medical teams will typically apply default treatment, which may not align with your wishes.

Is an advance directive the same as a living will?

A living will is one type of advance directive. The broader term "advance directive" includes living wills, healthcare proxies, DNR orders, and POLST forms. Many people complete both a living will and a healthcare proxy as a set.

Can my advance directive be overridden by my family?

In most states, a legally valid advance directive takes precedence over family objections. However, enforcement is not always smooth in practice — which is why choosing the right healthcare agent and having clear conversations with family members matters enormously.

What if I change my mind after I complete my advance directive?

You can change or revoke your advance directive at any time while you have mental capacity. Simply create a new document, sign and witness it correctly, and distribute it to replace the previous version. Inform your physician and healthcare agent of the change.

Related resources

• Why pre-planning your funeral is one of the kindest things you can do
• What is probate and do you have to go through it?
• How to get a death certificate: a step-by-step guide

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.

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