What Is an Advance Directive and Do You Need One?

The short answer: An advance directive is a legal document that states your wishes for medical care if you become unable to speak for yourself. It includes a living will (what treatments you want or don't want) and a healthcare proxy or durable power of attorney for healthcare (who makes decisions if you can't). Every adult over 18 should have one.

What Is an Advance Directive and Do You Need One?

Most people assume advance directives are for the elderly or terminally ill. The reality: accidents, strokes, and sudden illness can leave any adult unable to communicate their wishes. Without an advance directive, medical decisions fall to family members who may disagree, or to state default laws that may not reflect your values.

The Two Core Documents

Living Will: A written statement of your medical treatment preferences in specific situations. It answers questions like: Do you want CPR if your heart stops? Do you want to be placed on a ventilator? Do you want artificial nutrition and hydration if you cannot eat? Do you want aggressive treatment aimed at extending life, or comfort-focused care?

Healthcare Proxy / Durable Power of Attorney for Healthcare (DPOA-HC): Names a specific person (your healthcare agent or proxy) to make medical decisions on your behalf when you cannot. This person should know your values and wishes deeply, be able to advocate under pressure, and be available in a crisis.

What Is a POLST Form?

A POLST (Physician Orders for Life-Sustaining Treatment) — also called MOLST, MOST, or TPOPP in different states — is a medical order, not just an expression of wishes. It is signed by a physician and immediately actionable by emergency responders. A POLST is appropriate for people with serious illness or advanced age; an advance directive is appropriate for all adults.

What Happens Without One

Without an advance directive, if you become incapacitated:

• Medical decisions default to next of kin in a legally defined hierarchy (spouse → adult children → parents → siblings)
• Family members may disagree, potentially requiring court involvement
• Doctors may default to aggressive treatment rather than comfort care
• Your actual wishes may never be known or honored

How to Complete an Advance Directive

1. Get your state's specific form — requirements vary by state. CaringInfo.org (NHPCO) provides free state-specific forms.
2. Reflect on your values — What matters most to you? What does "quality of life" mean? What conditions would make life not worth living by your own definition?
3. Choose your healthcare proxy carefully — Select someone you trust completely to honor your wishes even when that's emotionally hard for them.
4. Complete and sign with witnesses/notary — Requirements vary by state; most require 2 witnesses who are not family members or heirs.
5. Share copies widely — Give copies to your healthcare proxy, your doctor, your hospital, and keep one accessible at home.
6. Review periodically — Update after major health events, after changes in relationships, or every 5 years.

Five Wishes

Five Wishes (available at fivewishes.org) is a comprehensive advance directive that addresses medical wishes, comfort measures, how you want to be treated as a person, what you want loved ones to know, and what you want for your funeral. It is legally valid in most US states and is written in plain language rather than legal jargon.

How Death Doulas Help With Advance Directives

Many death doulas are trained in advance care planning and can guide individuals and families through the process of completing advance directives — facilitating conversations about values, explaining the options, and ensuring documents are properly executed and shared with the right people.

Frequently Asked Questions

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

A living will is one component of an advance directive — it specifies your medical treatment preferences. An advance directive is the broader category that includes both a living will and a healthcare proxy designation (naming who makes decisions if you can't).

At what age should you get an advance directive?

Any adult over 18 should have an advance directive. Accidents, sudden illness, and strokes can leave anyone incapacitated at any age. Waiting until you're elderly or seriously ill is waiting too long.

What is a POLST form?

A POLST (Physician Orders for Life-Sustaining Treatment) is a medical order signed by a physician that is immediately actionable by emergency responders. Unlike an advance directive, which expresses wishes, a POLST is a direct medical order used for people with serious illness or advanced age.

Does an advance directive need to be notarized?

Requirements vary by state. Some states require notarization; others require two adult witnesses who are not family members or heirs. Check your state's specific requirements at CaringInfo.org or through your state health department.

What happens to my advance directive in an emergency?

Emergency responders (EMS) typically follow POLST forms if present, not advance directives. Advance directives are most actionable in hospital and medical settings. This is why completing both documents — the advance directive AND a POLST if appropriate — is important for seriously ill individuals.

Renidy connects grieving families with certified death doulas, funeral planners, and end-of-life specialists. Find compassionate support at Renidy.com.