As we grow older, planning ahead can be one of the kindest and most practical gifts we can give ourselves and our loved ones. Advance directives are legal tools that communicate your medical care wishes if you are ever unable to speak for yourself. They ensure that your values are protected, reduce confusion, and alleviate some of the burden on loved ones or caretakers of having to guess what you would have wanted. In fact, research shows that advance care planning improves care aligned with patient preferences, decreases unwanted medical interventions, and helps families feel more confident about end-of-life decisions. It should be viewed as an ongoing conversation rather than a single document, revisited and updated regularly to ensure it remains aligned with your current health, beliefs, and goals.
What Are Advance Directives?
An advance directive is a legal document that records your preferences for future medical care and treatment. It ensures that doctors and loved ones can follow your choices if you are unable to make or communicate decisions yourself.
Living Will: A written statement that outlines what kinds of medical treatment you would or would not want in specific situations. This can include choices about cardiopulmonary resuscitation (CPR), mechanical ventilation, feeding tubes, or dialysis.
Durable Power of Attorney for Health Care (or Health Care Proxy): A form that designates someone you trust to make health decisions on your behalf if you cannot.
POLST/MOLST (Physician Orders for Life-Sustaining Treatment / Medical Orders for Life-Sustaining Treatment): Medical orders signed by both you and your clinician that specify what life-sustaining treatments you wish to receive or decline. POLST or MOLST forms are designed for individuals with serious or chronic illnesses, making their wishes actionable in medical settings.
Do Not Resuscitate (DNR) Orders: A medical order instructing health care professionals not to perform cardiopulmonary resuscitation (CPR) if your heart stops or you stop breathing. DNR orders can exist in two forms: In-hospital DNR, documented in your hospital chart, and Out-of-hospital DNR, also known as a portable DNR, which is legal in many states and typically signed by the patient (or their representative) and a clinician. A DNR only applies to CPR and does not stop other treatments such as medications, oxygen, or comfort care.
Be aware that every U.S. state has its own specific laws and forms related to advance directives, so it’s essential to use the correct version for your state.
How to Create an Advance Directive
Reflect on What Matters Most
Begin by thinking about your values and what makes life meaningful to you. Is it independence, comfort, or being surrounded by family? Reflecting on your goals helps guide the specific choices you record in your advance directive.
Learn About Treatment Options
It’s easier to make informed decisions when you understand what each treatment entails. The National Institute on Aging (NIA), part of the U.S. Department of Health and Human Services, provides clear, easy-to-read guides that explain standard medical procedures and their implications for older adults. These resources help you decide what aligns with your values and health goals.
Choose a Health Care Proxy
Select someone you trust, a family member, close friend, or even a neighbor, who can communicate clearly with medical professionals. Discuss your wishes with them in advance so they are ready to advocate for you if needed.
Complete the Correct Legal Forms
Each state provides its own advance directive forms. You can often find these on your state’s Department of Health or Attorney General website. Some require witnesses or notarization. Completing these forms correctly ensures they are legally valid.
Share and Store Copies
Provide copies to your healthcare proxy, your primary doctor, and close family members. Ask your physician to include it in your electronic medical record. Medicare even covers advance care planning discussions during certain office visits, so your clinician can guide you through the process.
Review and Update Regularly
Review your directive every few years, or whenever your health changes significantly, after a new diagnosis, a major surgery, or the loss of a loved one. You can revise it at any time to reflect your current wishes.
Involving Family- How to Have the Conversation
Advance care planning is not only about paperwork; it’s about open communication.
- Start with values, not medical terms. Begin by saying what matters most to you: “I want to stay comfortable at home” or “I value quality of life over length of life.”
- Use examples. Concrete scenarios help family members understand your intentions: “If I could not breathe on my own and recovery was unlikely, I would not want to stay on a ventilator.”
- Normalize the discussion. Explain that you are planning ahead, just like you would with a will or financial plan. It’s a practical and caring step for everyone involved.
- Document the outcome. After talking with family, record your preferences on the official forms. Make sure your proxy and clinician have copies.
Practical Starting Points
- Ask your healthcare provider about advance care planning during your next primary care visit. Many clinicians are trained to guide these discussions and ensure your plans are legally recorded.
- Use advance care planning information from the National Institute on Aging, which offers step-by-step guidance written for older adults and caregivers.
- Visit your state’s health department website to download your official advance directive form. If you have a serious illness, ask whether a POLST or MOLST form would also be appropriate to make your wishes medically actionable.
Common Questions
Will my advance directive be honored?
Generally, yes, but it must be clear and applicable to the medical situation. A clinician can only follow the directive as specified. That’s why POLST or MOLST forms are beneficial for people with serious illnesses, as they serve as direct medical orders.
What if my family disagrees?
If you have named a health care proxy, that person’s decisions carry legal authority when you cannot make them yourself. Having clear documents and open discussions beforehand helps prevent conflict.