Only about one in three American adults has completed any form of advance directive, even though polling consistently shows that the great majority want a say in their own end-of-life care. Advance directives are the legal tools that let you keep that say even when you cannot speak for yourself. They sit at the intersection of medicine and law: simple to complete, surprisingly powerful, and most useful when written long before they are needed. They are also an act of generosity toward the people who would otherwise have to guess your wishes under pressure.
This guide explains what each document does — living wills, healthcare proxies, durable powers of attorney for healthcare, DNR and DNI orders, and POLST/MOLST forms — who needs which, how they differ, and how to make them legally enforceable in your state. It is general information, not legal or medical advice. For care contexts where these documents are routinely used, see our hospice care and palliative care guides. Broader health topics live in our medical conditions hub.
What Advance Directives Are
Advance directives are written instructions about future medical care that take effect if you are unable to make or communicate decisions. The two core documents are a living will (your written wishes about specific treatments) and a healthcare power of attorney — also called a healthcare proxy, healthcare agent, or healthcare surrogate (the person you designate to make decisions on your behalf). The National Institute on Aging notes that combining both documents in a single advance care plan is generally the most robust approach, because a living will cannot anticipate every situation and a proxy can respond to circumstances your document never mentioned.
State laws govern the specific forms, witnessing, and notarization requirements, and those rules vary from state to state. Documents valid in one state are usually honored in another, but if you move or spend significant time across state lines, it is wise to complete the local form for each state. Advance directives are not just for the elderly or the seriously ill — a sudden accident or stroke can leave anyone unable to speak for themselves — which is why even healthy adults in their 30s and 40s benefit from naming a proxy.
Living Wills
A living will spells out which treatments you would or would not want under specific scenarios — typically terminal illness, permanent unconsciousness, persistent vegetative state, or an end-stage condition. Common items include cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition and hydration (tube feeding), dialysis, antibiotics, and a general preference for comfort-focused versus life-prolonging care. Many living wills also let you record wishes about organ and tissue donation.
Living wills are most useful when they are specific. “I would not want extraordinary measures” leaves clinicians and family guessing. “If I have advanced dementia and cannot recognize family or feed myself, I do not want a feeding tube or hospitalization for infections — keep me comfortable at home or in hospice” gives a clear directive. Many states publish standardized living will templates with guided prompts, and thinking through your values in advance — what a good day looks like to you, and what outcomes you would find unacceptable — makes the document far more useful to those who must apply it.
Healthcare Proxy or Durable Power of Attorney for Healthcare
A healthcare proxy designates a person — your “agent” — to make medical decisions for you when you cannot. The terminology varies by state: durable power of attorney for healthcare, healthcare surrogate, healthcare agent, or simply healthcare proxy. They mean essentially the same thing.
Choosing an agent is the most consequential decision in advance care planning. The right person knows your values, can be reached quickly, can stay calm and decide under pressure, and can stand up to other family members and to clinicians when needed. Spouses are common defaults but not always the best choice — a spouse may struggle to authorize hospice or to withdraw a ventilator. Adult children, siblings, or trusted friends can be excellent choices. Naming at least one alternate is wise in case your first choice is unavailable. Above all, talk with the person before naming them, and make sure they are willing to serve and understand what you would want.
The agent’s authority typically activates only when a physician documents that you lack the capacity to make your own decisions, and it ends if you regain capacity. Agents are bound to follow your previously stated wishes when those are known, and otherwise to make decisions in your “best interest” using their knowledge of your values. Note that a financial power of attorney is a separate document and usually does not cover healthcare decisions.
DNR and DNI Orders
A do-not-resuscitate (DNR) order is a physician order specifying that CPR will not be performed if your heart stops. A do-not-intubate (DNI) order specifies no mechanical ventilation. These are medical orders signed by a clinician — not patient documents like a living will. They live in your medical record (and often on a wallet card, bracelet, or refrigerator form) so that paramedics and ER staff can act on them quickly.
DNRs typically apply within specific facilities (a hospital or nursing home) or, out in the community, only with a state-specific out-of-hospital DNR form. Without a properly executed out-of-hospital DNR, EMS responding to a 911 call is generally required to attempt resuscitation regardless of what your living will says. This is one reason patients enrolling in hospice care typically receive an out-of-hospital DNR as part of admission. If avoiding resuscitation matters to you and you are seriously ill, ask your clinician specifically about your state’s out-of-hospital DNR process.
POLST and MOLST Forms
Physician Orders for Life-Sustaining Treatment (POLST) — called MOLST, POST, or MOST in different states — translate a seriously ill patient’s preferences into a portable medical order signed by a clinician. POLST is meant for people with advanced illness or frailty for whom death within a year would not be surprising, not for healthy adults. It is completed through a conversation with your clinician, who signs it.
The form usually covers CPR preference, the overall level of medical intervention (full treatment, selective treatment, or comfort-focused care), and artificial nutrition. Because it is a medical order, POLST follows the patient across settings — home, ambulance, hospital, nursing facility — and is honored by EMS in participating states. It complements rather than replaces a living will and healthcare proxy: the proxy still names your decision-maker, the living will still records your broader values, and POLST puts actionable orders in place for the near term.
How to Complete Advance Directives
You do not need a lawyer for most advance directives. Free, state-specific forms are available from CaringInfo (a program of NHPCO), state attorney general or health-department websites, hospitals, and many primary care offices. Requirements vary by state: most require either two witnesses or notarization, and some have specific witness-eligibility rules — for example, the witness may not be your named agent, a relative, a beneficiary, or your healthcare provider. CaringInfo emphasizes that states differ in their witnessing and notarization rules, so read your state form’s instructions carefully and follow them exactly, or the document may not be valid.
Medicare’s advance care planning benefit covers a dedicated visit with your physician or qualified clinician to discuss and complete advance directives, and this can be provided separately from (or as part of) the annual wellness visit. Most clinicians welcome the conversation. After completing your documents, give copies to your healthcare agent and any alternate, your primary care doctor, your local hospital, and close family, and upload them to your patient portal where supported. Consider carrying a card noting that you have a directive and who your agent is.
Common Mistakes to Avoid
The most common mistake is completing a document and never telling anyone — proxies cannot act on directives they have never seen. Another is assuming a financial power of attorney also covers healthcare decisions; it usually does not. A third is locking the documents in a safe deposit box that no one can reach on a Saturday night when a decision must be made. A fourth is naming an agent without ever discussing your wishes with them, which leaves your chosen person guessing under the worst possible pressure.
Wishes change. After a major diagnosis, a hospitalization, the loss of a spouse, a divorce, or a shift in your values, advance directives should be reviewed and updated. Older versions should be physically destroyed and replaced, because superseded documents still in circulation create dangerous confusion. Many palliative care teams routinely revisit advance directives at each visit, and reviewing yours every few years is a good habit even when nothing has changed.
When to seek emergency care vs call hospice: If you have an active out-of-hospital DNR and are enrolled in hospice or have explicitly chosen comfort-focused care, call your hospice’s 24/7 nurse line first for symptom crises rather than 911. If you do not have a DNR or are not on hospice, call 911 for any acute medical emergency — your advance directive will be reviewed once you reach the hospital, and your agent can authorize treatment limits at that point.
Frequently Asked Questions
Do I need a lawyer to complete an advance directive?
Generally no. State-specific forms are designed for self-completion. A lawyer can help with complex family or estate situations, but is not required for the medical documents themselves. Just make sure you follow your state’s witnessing or notarization rules exactly.
Will my living will be honored if I am admitted to a hospital in another state?
Most states honor out-of-state directives, though the legal mechanics vary and are not guaranteed. The healthcare proxy designation is generally the most portable element. If you split your time between two states, completing the local form for each is the safest approach.
Can my healthcare agent override my living will?
An agent is generally bound to follow your known, clearly stated wishes. Where the living will is silent or ambiguous, the agent applies their judgment of your values. Conflicts that reach an institutional ethics committee usually favor clearly documented written wishes.
Should I have advance directives if I am healthy?
Yes. The most useful directives are completed before they are needed. Sudden illness, an accident, or a stroke can render anyone unable to speak for themselves, so even adults in their 30s and 40s benefit from at least naming a healthcare proxy.
What is the difference between a living will and a POLST?
A living will is a patient document stating your general treatment wishes for future scenarios, useful for anyone. A POLST (or MOLST) is a portable medical order signed by a clinician for people who are already seriously ill or frail, giving actionable instructions that EMS and hospitals follow across settings. They work best together.
Disclaimer: This article is for general informational purposes only and is not legal or medical advice. Advance directive laws, forms, witnessing, and notarization requirements vary by state and change over time — use your own state’s current form and confirm its rules, or consult a qualified attorney or your clinician for your situation. DNR, DNI, and POLST/MOLST are clinician-signed medical orders that should be completed with your physician. Give copies to your agent and care team, because a directive only helps if the people who need it can find and follow it.
The Bottom Line
Advance directives are an act of generosity — to your future self and to the people who would otherwise have to guess what you would want. Completing a living will and naming a healthcare proxy takes an afternoon and costs nothing in most states. Telling your agent and primary care clinician what you wrote, giving them copies, and updating the documents every few years or after major life events is what turns paper into protection. The Medicare advance care planning benefit gives you a dedicated visit to do this with your physician, and most people leave that conversation feeling lighter, not heavier — because they have taken control of a decision most of us would rather not leave to chance.
Sources
- National Institute on Aging (NIA) — advance care planning and advance directives (living will, durable power of attorney for healthcare, DNR, POLST; combining documents)
- CaringInfo, a program of NHPCO — free state-specific advance directive forms; states vary in witness and notarization requirements
- MedlinePlus — advance directives (living will and durable power of attorney for health care)
- American Bar Association — health care advance planning and choosing a healthcare agent
- Medicare.gov — advance care planning benefit