Advance care planning is the process of deciding what medical care you’d want if you became too sick or injured to speak for yourself, then putting those wishes into legal documents and sharing them with the people who need to know. It covers everything from whether you’d want life-sustaining treatment to who should make decisions on your behalf. Despite a common assumption that it’s only for the elderly or terminally ill, an emergency can happen at any age, making this relevant for any adult.
What Advance Care Planning Actually Involves
At its core, advance care planning is an ongoing conversation, not a one-time form you fill out. It starts with reflecting on your own values: what matters most to you in terms of quality of life, comfort, independence, and how aggressively you’d want doctors to intervene. From there, you talk with your doctor about your current health and the kinds of decisions that could realistically come up. Someone with high blood pressure, for example, might ask what choices they’d face if that condition led to a stroke.
After those conversations, you choose a trusted person to serve as your healthcare proxy (the person who speaks for you when you can’t), complete the legal paperwork, distribute copies, and revisit everything periodically. The planning part never truly ends. Your health changes, your relationships change, and your documents should keep pace.
The Key Legal Documents
Advance care planning typically produces two core documents, and they serve different purposes.
A living will is a written legal document that spells out the specific medical treatments you would or wouldn’t want used to keep you alive. It also covers related choices like pain management preferences and organ donation. It only takes effect when you’re unable to make decisions yourself.
A durable power of attorney for healthcare (sometimes called a healthcare proxy or medical power of attorney, depending on your state) names the person authorized to make medical decisions on your behalf. This document matters because no living will can anticipate every possible situation. Emergencies, unexpected complications, and new treatment options all require someone who understands your values to make judgment calls in real time.
Some people also encounter a form called a POLST (Portable Orders for Life-Sustaining Treatment, also known as MOLST in some states). A POLST is a medical order, not just a directive. It records which advance directives you have and who your healthcare proxy is, and it travels with you between care settings so emergency responders and hospital staff can act on your wishes immediately.
How to Choose a Healthcare Proxy
Your proxy must be at least 18 in most states (19 in Alabama and Nebraska) and of sound mind. Beyond those legal basics, the person you choose should be someone you trust deeply and can talk to openly about difficult topics. The American Bar Association recommends against choosing your doctor or anyone employed by your healthcare provider, the owner or operator of your care facility, or anyone who already serves as proxy for 10 or more other people.
When weighing your options, ask yourself a few practical questions. Will this person actually honor your wishes, even under pressure from other family members who may disagree? Can they handle conflict in a hospital waiting room? Do they live close enough to be present when decisions need to be made, or would they be willing to travel? You don’t need to choose a family member. A close friend or even your lawyer can serve as proxy, as long as you trust them to follow through.
Once you’ve chosen someone, have the conversation before anything is urgent. If you’re not ready to discuss specific treatments, start with general preferences. Some people find it easier to write a letter or watch a video together as a way to open the discussion.
Making Your Documents Legal
Requirements for making advance directives legally valid vary significantly from state to state. Some states require witness signatures, others require notarization, and some require both. Each state has its own advance directive forms with specific instructions, so review them carefully. Organizations like CaringInfo offer free, state-specific forms you can download.
Once your documents are completed and formalized, make multiple copies. Give them to your healthcare proxy, your primary care doctor, your lawyer, and any close family members who should be aware. Some states maintain registries where your advance directive can be stored electronically for quick access by healthcare providers. Keep the originals in a safe but accessible place. A locked safe deposit box that no one else can open defeats the purpose.
Medicare Covers These Conversations
If you’re on Medicare, advance care planning discussions are covered as part of your annual wellness visit. When the conversation happens during that visit with the same provider, you pay nothing out of pocket: the deductible and coinsurance are waived. Medicare also covers advance care planning as a separate service outside of wellness visits, and there’s no limit on how many times per year you can have these conversations. The only requirement is that your provider documents changes in your health or wishes to justify repeated sessions.
If you have private insurance, check with your plan, as coverage varies.
When to Update Your Plan
Advance directives don’t expire unless you specifically set an expiration date. But a document you wrote at 35 may not reflect your priorities at 55. A useful framework for knowing when to revisit your plan is the “5 Ds”:
- Death of a loved one (especially if that person was your proxy)
- Divorce or separation
- Decade birthday or other milestone
- Diagnosis of a significant illness or injury
- Decline in your overall health
Even without a major trigger, reviewing your documents at least once a year is a good habit. When you do update them, keep the old versions on file and note the date they were replaced. If your state has a registry, make sure the latest version is uploaded.
Why It Matters for You and Your Family
The practical benefits of advance care planning extend well beyond paperwork. People who have a plan in place tend to receive care that more closely matches what they actually want, experience fewer unwanted hospitalizations near the end of life, and report higher trust in their providers. For families, the impact can be just as significant. When a loved one’s wishes are clearly documented, the family members left making decisions experience less psychological distress and guilt. Instead of agonizing over what the right choice might be, they can focus on honoring preferences that were already clearly communicated.
The hardest part of advance care planning is usually starting the conversation. The documents themselves are straightforward. What takes courage is sitting with someone you love and talking honestly about what you’d want if the worst happened. But that single conversation can spare your family from one of the most painful experiences in medicine: guessing.