Creating an advance directive involves two core steps: writing down your medical treatment preferences in a living will and naming someone to make healthcare decisions on your behalf through a durable power of attorney for healthcare. You don’t need a lawyer to do either one. Most states provide free forms you can download, fill out, and sign with a witness or notary.
The process is straightforward, but the decisions inside it require real thought. Here’s how to work through each part.
The Two Documents You Need
An advance directive is actually a package of two separate legal documents. A living will spells out the specific treatments you do or don’t want if you can’t speak for yourself during a medical emergency. A durable power of attorney for healthcare names a person, called a healthcare proxy or agent, who can make medical decisions on your behalf when you’re unable to communicate.
You can complete one without the other, but having both gives you the strongest protection. A living will covers scenarios you can anticipate. A healthcare proxy covers everything you can’t.
Decisions to Think Through First
Before you sit down with a form, spend time thinking about what matters to you. A living will typically addresses your preferences on several specific interventions:
- CPR and resuscitation. Whether you want emergency teams to attempt to restart your heart if it stops. Refusing this is documented as a Do Not Resuscitate (DNR) or Allow Natural Death order.
- Mechanical ventilation. Whether you want to be placed on a breathing machine if you can’t breathe on your own. Declining this is called a Do Not Intubate (DNI) order.
- Feeding tubes and artificial nutrition. Whether you want a tube placed in your stomach to deliver food and fluids. These are generally not recommended for patients with severe dementia.
- Other interventions. IV fluids, dialysis, blood transfusions, antibiotics, and whether you’d want to be admitted to a hospital or intensive care unit at all.
These choices often depend on context. You might want aggressive treatment after a car accident but not if you have a terminal illness with no chance of recovery. Good advance directive forms let you distinguish between these scenarios rather than forcing a blanket yes or no.
Choosing Your Healthcare Proxy
This is the most important decision in the entire process. Your proxy will interpret your wishes in situations your living will doesn’t cover, and they may face pressure from family members, friends, or doctors who disagree with your choices.
In most states, your proxy must be at least 18 (19 in Alabama and Nebraska) and of sound mind. The American Bar Association recommends against choosing your doctor or anyone employed by your healthcare provider, the owner or operator of your care facility, someone appointed as your legal guardian, or anyone who already serves as proxy for 10 or more other people.
Beyond the legal restrictions, ask yourself a few practical questions. Is this person comfortable talking about death and medical decisions? Will they actually follow your wishes even if it’s emotionally difficult? Can they stand firm if your siblings, spouse, or parents push back? Do they live close enough to get to you, or would they be willing to travel? Trust and emotional resilience matter more here than medical knowledge.
You can also define the scope of your proxy’s authority. Some people grant broad decision-making power covering everything from choosing doctors to deciding about organ donation and what happens to their body after death. Others limit the proxy to a few specific decisions. Your document should spell out exactly how much control you’re granting.
Getting the Right Forms
Every state has its own advance directive form and its own rules about what makes one legally valid. You do not need an attorney to complete these forms, though you can hire one if your situation is complex.
Free, state-specific forms are available from several sources. CaringInfo, a program of the National Alliance for Care at Home, provides forms for all 50 states. Many state health departments publish their own forms directly. Oregon, for example, posts downloadable forms along with a user’s guide that walks you through each section. Some states, like California, even maintain official registries where you can file your completed directive.
Whatever form you use, make sure it meets your state’s requirements. Some states require one or two witnesses to watch you sign. Some require notarization. A few require both. Witnesses typically cannot be the same person you’ve named as your healthcare proxy, and many states prohibit your doctor or healthcare facility employees from serving as witnesses.
What About POLST Forms?
You may have heard of a POLST (Portable Orders for Life-Sustaining Treatment), sometimes called MOLST in some states. This is a different document. A POLST is a medical order signed by your doctor that travels with you, including in ambulances. It was originally designed so emergency medical teams could quickly see your treatment preferences without searching for legal paperwork.
A POLST is not a replacement for an advance directive. It’s a complement to one. Advance directives are broad legal documents that cover a range of future scenarios. A POLST translates your current wishes into specific, actionable medical orders. If you have a serious illness or are in later stages of life, ask your doctor whether a POLST makes sense alongside your advance directive.
Signing and Storing Your Directive
Once you’ve filled out your forms, follow your state’s requirements for signing, witnessing, or notarizing. Then comes the step most people skip: making sure the document is actually accessible when it’s needed.
An advance directive locked in a safe deposit box is essentially useless during an emergency. Keep the original in a safe but easy-to-find place at home, and tell your proxy and close family exactly where it is. Make multiple copies and distribute them to your healthcare proxy, your primary care doctor, close family members, and anyone else likely to be involved in your care. Many hospitals will file a copy in advance so it’s already on record if you’re admitted. Bring a copy with you any time you check into a hospital or have a planned procedure.
For digital backup, several services store scanned copies online and make them available on demand from anywhere. MedicAlert, MyDirectives by AD Vault, and the U.S. Advance Care Plan Registry all offer this. Some are free. You can also store a photo or scan on your phone and in cloud storage.
If You Move or Change Your Mind
Many states honor advance directives from other states, though the specifics vary. New Jersey, for example, explicitly recognizes directives valid in other states. If you relocate, it’s still wise to complete a new directive using your new state’s form, since local healthcare providers will be most familiar with their own state’s format and requirements.
You can revoke or update your advance directive at any time, as long as you still have the mental capacity to make informed decisions. In most states, simply creating a new directive automatically invalidates the old one. If your state has a registry, like California’s, you’ll need to file an amendment or a new registration. The key step people forget: after updating your directive, collect and destroy old copies and redistribute the new version to everyone who had one. An outdated directive floating around a doctor’s office can cause exactly the kind of confusion these documents are meant to prevent.
Life events that should trigger a review include a new diagnosis, a marriage or divorce, the death of your named proxy, a major surgery, or simply a change in how you feel about end-of-life care. Even without a triggering event, revisiting your directive every few years keeps it aligned with your current values.
Who Can Create One
Any adult is legally presumed capable of creating an advance directive. No specific diagnosis, including dementia or mental illness, automatically disqualifies someone. What matters is whether you can understand the decisions you’re making at the time you sign. This is called “decisional capacity,” and it’s assessed based on your ability to understand, reason, and communicate, not on a label in your medical chart.
There’s no minimum health threshold either. Healthy 25-year-olds benefit from advance directives just as much as 80-year-olds with chronic conditions. Accidents and sudden illness don’t wait for preparation, and having a directive in place means your family won’t be forced to guess what you’d want during the worst moment of their lives.