What Is an Advance Directive?
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An advance directive is an umbrella term that includes living wills, medical power of attorney and other documents. These documents give instructions for your medical care if you are unable to communicate consent to medical procedures. An advance directive only works when you don’t, so if your condition improves and you can communicate again, you’ll be able to override the document.
Some directives include do-not-resuscitate orders, comfort care preferences and organ donation instructions. Your doctor might ask you for such directives before risky surgeries or medical procedures. Or, you might share them with your providers proactively in an effort to make your preferences known.
These documents may have different legal requirements depending on which state you live in, but their main purpose is to give you more control over your medical care and help your loved ones advocate for you in case of an emergency.
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What kinds of advance directives are there?
Living wills specify the medical treatment you want — or don’t want — if you aren’t able to make those decisions. Whether or not this document is legally binding depends on state law, and it often can’t be used to give power of attorney to another person.
Advance directives do have legal status in the U.S., meaning that medical providers must respect your written wishes to the best of their ability. However, they still can refuse to perform certain procedures if they object for moral reasons, as long as they provide the necessary documentation and state law permits it.
Living wills can include preferences for resuscitation, ventilation, feeding tubes, comfort care, and postmortem organ and medical research donations.
Depending on your circumstances, you may want to get more specific about certain medical situations. Your living will can serve as a general guide, but if you’re at risk for something like cardiac arrest and don’t want CPR performed, or feel strongly about organ donation, it can be helpful to include an additional document outlining your wishes.
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Medical power of attorney or health care proxy
A power of attorney or health care proxy gives a trusted person — and a backup if you prefer — authority to make decisions on your behalf.
Since many states have limitations on living wills, it’s important to prepare another legal document to name someone to make medical decisions for you if you can’t communicate. This is especially helpful if medical standards change, or if you’re in a situation that your living will doesn’t specifically cover.
The American Bar Association has a free power of attorney form for download that is legally binding in all states except for Indiana, New Hampshire, Ohio, Texas and Wisconsin.
This person will act as your advocate in medical settings, using your living will as a guide. It should be someone you trust to make decisions in your best interest, which may not always be your closest relative; for example, a spouse may want to preserve your life at all costs, while you may prefer not to be on life support.
It’s helpful to name a backup proxy in case of an emergency and to prepare both people in advance by discussing your other documents with them.
To streamline your medical directives, consider combining your living will and power of attorney documents into a single form that can be used as a comprehensive guide for your loved ones and medical providers.
A popular option in the U.S. is called Five Wishes, created by the nonprofit organization Aging with Dignity. It can be completed online and has provisions for all 50 states.
It includes the following directives:
The person I want to make care decisions for me when I can't: Your health care proxy or power of attorney document.
The kind of medical treatment I want or don't want: Your living will.
How comfortable I want to be: Preferences for pain management, hospice care, grooming and bathing.
How I want people to treat me: Includes visitation preferences such as prayer, touch and location.
My wish for what I want my loved ones to know: Includes burial preferences, desires for mourning and how you’d like to be remembered.
How to make an advance directive
If you’re working with an attorney to create an estate plan, they can help you write your advance medical directives in the process. But you actually don’t need an attorney for this; your directive becomes legally valid as soon as you sign it in front of the required witnesses (though requirements vary by state).
You can use estate planning software to craft a living will and power of attorney document or print out the forms from a website. Make sure the product you choose explains how to make the document legally binding for your state and includes all the possible options you need.
AARP, an interest group for people over 50, and Everplans — a service that helps people organize their important documents — both offer links to free forms for each state.
Five Wishes offers an interactive printable version of their directive for $5 and a fully-online version for $15.
Prepare for Your Care, an online resource that helps people make medical decisions, offers free forms with clear instructions and specific questions about your quality of life and your values.
Once you’ve completed your forms, give copies to your doctor, close family members and attorney — if you have one — and store extra copies securely. Ask your doctor to add the forms to your electronic health record, too, so other providers can access them in an emergency.
It’s also helpful to carry a card in your wallet, like those from the American Hospital Association, with information on your advance directives.
How to change an advance directive
Advance directives can be changed at any time, as long as you are able to do so. It’s best to create a new directive using the same method as your original documents. Make sure to update your family, doctor and attorney with the new information and destroy the original documents.
In some states, you can officially register your advance medical directive, so you’ll need to register a new form and pay a small fee to make any changes. Registering a form is voluntary, however.
It’s a good idea to review your advance directive around every 10 years, or if you receive a new medical diagnosis or change your marital status.
State-by-state advance directive laws
The legal standards for living wills and power of attorney vary by state. For example, Five Wishes meets legal requirements for an advance directive in all states except Kansas, New Hampshire, Ohio and Texas. In these states, you’ll need to fill out an additional statutory form.
Make sure you download the forms specific to your state. Your attorney or estate planning software can help you do this. In some states, you’ll need to have a witness sign or get the documents notarized.