How to Write an Advance Directive

The short answer: Writing an advance directive takes less than an hour and requires no attorney. You need: (1) your state's advance directive form (free online), (2) clear decisions about your values and wishes, (3) a chosen healthcare proxy, (4) two witnesses and/or a notary as required by your state. The most important step is giving copies to your doctor, hospital, healthcare proxy, and anyone else who might need it.

What Is an Advance Directive?

An advance directive is a legal document that communicates your healthcare wishes and designates someone to make medical decisions for you if you become unable to make them yourself. It is the most important document you can complete for end-of-life planning — and one of the most overlooked. Fewer than 40% of Americans have completed an advance directive, yet having one dramatically reduces family conflict, unwanted treatment, and the chance of dying in a way that doesn't reflect your values.

The term "advance directive" is an umbrella that includes several document types:

• Healthcare Power of Attorney (HCPOA) / Healthcare Proxy: Designates a specific person to make medical decisions on your behalf
• Living Will: Specifies what treatments you do or do not want under specific circumstances
• Combined Advance Directive: Most states provide a single form that covers both
• POLST/MOLST/MOST: A medical order (different from an advance directive) completed with your doctor for serious illness — legally binding on EMS and care providers

Step 1: Get Your State's Form

Advance directives are governed by state law, and each state has its own required or recommended form. Using your state's specific form ensures it will be recognized by healthcare providers in your state. Free forms are available from:

• CaringInfo.org (National Hospice and Palliative Care Organization) — free state-by-state forms
• Your state's attorney general website
• Your doctor's office or hospital
• The Five Wishes document — legally valid in most states, more conversational format

Step 2: Choose Your Healthcare Proxy

Your healthcare proxy (also called healthcare agent, patient advocate, or surrogate) is the person who will make medical decisions on your behalf if you cannot. This is often the most important decision in the entire document. Consider:

• Who can handle high-stress medical situations calmly and decisively?
• Who will honor your wishes even if they personally disagree?
• Who is available — geographically and in terms of life circumstances?
• Who do you trust completely?

Your proxy does not need to be a spouse or family member. It can be a close friend, a trusted advisor, or anyone you choose. It should not be your doctor or a healthcare provider who is caring for you.

Have the conversation. Before naming someone as your proxy, have a thorough conversation about your values and wishes — including in scenarios you might prefer not to think about. Your proxy should understand not just your specific wishes but your underlying values, so they can make good decisions in situations not specifically covered by your document.

Step 3: Think Through Your Values and Wishes

The most meaningful advance directives are specific about values, not just procedures. Consider:

• Quality of life vs. length of life: What constitutes a quality of life worth living for you? What conditions would make life no longer worth prolonging?
• Specific interventions: What is your preference about CPR, mechanical ventilation, feeding tubes, dialysis, and IV fluids — particularly if there is little or no chance of meaningful recovery?
• Cognitive states: If you have advanced dementia and no longer recognize family members, would you want aggressive treatment for a separate illness?
• Where you want to die: Home, hospice, hospital — does this matter to you?
• Organ and tissue donation: Your preferences (note: this is separate from the donor designation on your license)
• Spiritual and cultural values: Any faith-based considerations, rituals, or people whose presence matters

Step 4: Complete the Form

Fill out the form using your decisions from Step 3. Be as specific as possible within the form's structure. Many forms include space for free-text personal statements — use this to express your values in your own words, which gives your proxy guidance for situations not specifically enumerated.

Step 5: Sign and Witness

Requirements vary by state but typically include:

• Your signature (dated)
• Two witnesses who are not your healthcare proxy, not your heirs, and not your healthcare providers (requirements vary)
• Notarization (some states require this; others do not)

Some states (like California) allow DocuSign for witness signatures; others require handwritten signatures.

Step 6: Distribute Copies

A signed advance directive that sits in a filing cabinet is useless in an emergency. Give copies to:

• Your primary care physician (ask to have it added to your medical record)
• Any specialists you see regularly
• Your hospital (if you have a hospital where you receive care)
• Your healthcare proxy (they must have it to present in an emergency)
• A trusted family member or friend beyond your proxy
• Your estate attorney if you have one

Keep the original in a known, accessible location — not a safe deposit box.

Advance Directive Registries

Many states maintain advance directive registries where you can upload your document for healthcare providers to access electronically. MyDirectives.com is a national digital advance directive platform. Check your state's health department for state-specific registry options.

Review and Update Periodically

An advance directive should be reviewed after any major health change, after a significant life event (divorce, death of proxy, move to a new state), or at minimum every 5 years. Ensure the proxy you named is still the right person and still willing to serve.

Frequently Asked Questions

Do I need a lawyer to write an advance directive?

No. Advance directives do not require an attorney. Free state-specific forms are available at CaringInfo.org (National Hospice and Palliative Care Organization) and from your state's attorney general website. You need to sign the form with witnesses and/or notarization as required by your state.

What is the difference between an advance directive and a living will?

A living will is a type of advance directive that specifies your treatment preferences. An advance directive is the broader term that includes both a living will and a healthcare power of attorney (proxy designation). Most states provide combined forms that cover both.

Who should I choose as my healthcare proxy?

Choose someone who can handle medical emergencies calmly, will honor your wishes even if they disagree, is available and accessible, and understands your values deeply. Have a thorough conversation with them before designating them — they need to understand your values, not just your specific wishes.

Where should I keep my advance directive?

Give copies to your primary care physician, your healthcare proxy, your hospital's medical records, and trusted family members. Keep the original in an accessible location — not a safe deposit box. Consider uploading to a digital registry like MyDirectives.com for electronic access.

Can a death doula help me complete an advance directive?

Yes. Advance care planning facilitation is one of the core services offered by death doulas. They help facilitate the values conversations that make advance directives meaningful — going beyond form completion to ensure the document reflects who you truly are and what matters most to you.

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