Getting an advance directive is straightforward and free. You don’t need a lawyer. The process involves reflecting on your medical preferences, choosing someone to speak for you if you can’t, filling out your state’s legal forms, and distributing copies to the right people. Most people can complete everything in an afternoon, though the conversations that come with it may unfold over days or weeks.
What an Advance Directive Actually Includes
An advance directive is typically two documents bundled together. The first is a living will, which spells out the types of medical treatment you do or don’t want if you become unable to communicate. This covers things like CPR, mechanical ventilation, feeding tubes, and organ donation. The second is a durable power of attorney for health care (sometimes called a health care proxy), which names a specific person to make medical decisions on your behalf.
You can complete one without the other, but having both gives you the most protection. A living will covers the scenarios you can anticipate, while a health care proxy covers everything you can’t.
Step 1: Reflect on What Matters to You
Before touching any paperwork, spend time thinking about your values around medical care and quality of life. The forms will ask you to make concrete choices, so it helps to consider questions like: Would you want to be kept alive on a ventilator with no reasonable chance of recovery? How do you feel about artificial nutrition? What does an acceptable quality of life look like to you?
You don’t need to have every answer figured out right away. Even broad preferences (“I’d rather prioritize comfort over extending life” or “I want every possible intervention”) give your proxy and medical team something meaningful to work with.
Step 2: Talk With Your Doctor
A conversation with your doctor can ground your preferences in reality. They can explain which medical decisions are most likely to come up given your specific health conditions. If you have high blood pressure, for example, they might walk you through what decisions would arise after a stroke. This turns abstract questions into practical ones. Medicare covers advance care planning as part of your annual wellness visit. If you have private insurance, check whether your plan does the same.
Step 3: Choose Your Health Care Proxy
Pick someone you trust to make medical decisions under pressure, even when those decisions are emotionally difficult. This person should be willing to advocate for your wishes even if other family members disagree. Good candidates include a spouse, adult child, close friend, or member of your faith community. Your proxy cannot be your doctor or anyone on your medical care team.
Look for someone who:
- Is comfortable discussing end-of-life topics openly
- Can follow your stated wishes even if they personally disagree
- Will speak up assertively in a hospital setting
- Lives close enough (or is reachable enough) to respond quickly in an emergency
Once you’ve chosen someone, have a real conversation with them. Share your values and specific preferences so they’re not guessing in a crisis. If you’re not ready for a detailed discussion, start with your general outlook and build from there. Writing a letter or watching a video about advance care planning together can help open the door.
Step 4: Get and Complete Your State’s Forms
Every state has its own advance directive form with its own legal requirements. You can download your state’s form for free from organizations like the American Bar Association, AARP, or the National Hospice and Palliative Care Organization (NHPCO) through their CaringInfo program. Your doctor’s office or local hospital may also have copies.
The forms walk you through each decision with checkboxes and fill-in sections. You’ll indicate your preferences for life-sustaining treatment, pain management, organ donation, and who you’re naming as your proxy. Read each section carefully, and review the completed forms with both your doctor and your proxy to make sure nothing is ambiguous or incorrectly filled out.
Witness and Notary Requirements
Most states require two adult witnesses to watch you sign and then sign the document themselves. The specific rules vary. In Florida, for instance, your designated proxy and alternate proxy cannot serve as witnesses, and at least one witness must not be your spouse or blood relative. Some states require notarization on top of witnessing; others, like Florida, do not. Check your state’s form carefully, as the instructions are usually printed right on it.
If you’re physically unable to sign, most states allow someone else to sign on your behalf in your presence, at your direction, and in front of your witnesses.
Step 5: Distribute and Store Your Documents
A completed advance directive does nothing if no one can find it in an emergency. Once your forms are signed and witnessed:
- Keep the originals in a safe but easily accessible place (not a safe deposit box, which may be hard to open quickly)
- Give copies to your health care proxy
- Give copies to your primary care doctor and any specialists who treat you regularly
- Give copies to your lawyer, if you have one
- Let close family members know the documents exist and where to find them
Some states maintain official registries where you can file your directive for quick access. California, for example, runs an Advance Health Care Directive Registry through the Secretary of State’s office. You can submit a copy of the directive itself or simply register its location. Check whether your state offers a similar registry.
When to Update Your Directive
An advance directive isn’t a one-and-done document. Review it at least once a year, and revisit it after any major life change. Estate planning professionals use a helpful framework called the “5 Ds” to flag when it’s time for a review:
- Death of a family member or close friend (especially if they were your proxy)
- Divorce or major relationship change
- Diagnosis of a new medical condition
- Decline in your overall health
- Decade milestone (turning 40, 50, 60, etc.)
When you update your directive, don’t throw away the old version. Keep it on file with a note indicating the date it was replaced. Distribute the new version to everyone who had a copy of the old one, and update any state registry you’ve used.
You Don’t Need a Lawyer, but It’s an Option
Advance directives are specifically designed so that any adult can complete them without legal help. The state-specific forms available through AARP, the NHPCO, and similar organizations are legally valid as long as you follow your state’s signing and witnessing requirements. A lawyer can be useful if your situation is complicated (blended families, disagreements among potential proxies, significant assets tied to medical decisions), but for most people the free forms are all you need.
The cost of having a lawyer draft or review an advance directive typically runs between $150 and $500, depending on your location and whether it’s bundled with other estate planning documents. If you’re already working with an estate planning attorney on a will or trust, ask them to include your advance directive in the same engagement.