Healthcare Directives: What to Know Before You Need One

A healthcare directive, also called an advance directive, is a written document that records your wishes for medical care and can name someone to make decisions for you if you cannot speak for yourself. People often think about these documents only after a serious illness or accident. Many families find that it is easier to talk through the choices while everyone is well. This article describes the main types in general terms. It is not a form, and it does not say which medical choices to make.

Why these documents matter

If you are unconscious or unable to communicate, doctors and hospitals still need to make decisions about your care. Without a written directive or an appointed decision-maker, family members may disagree about what you would want. Some people then need to ask a court to appoint a guardian, which can take time and add stress during an already difficult period.

A healthcare directive can reduce that uncertainty. It can show what treatments you would or would not want, and who you trust to speak for you. It can also be changed or revoked while you are able to make decisions.

The main types

Two documents are most common, although names and rules differ by state.

A health care proxy or healthcare power of attorney names an agent to make medical decisions for you when you cannot decide. The agent is generally expected to follow your known wishes and, when those are unclear, to act in your medical interest as they understand it. Because the agent is often the person doctors will call first, it is important that they know your values and are willing to serve.

A living will describes the medical treatments you would or would not want in certain situations, such as being in a permanent coma or having a terminal condition. Living wills are generally used when you cannot communicate your choices in the moment. Their scope varies, and some states use different names for similar documents.

Some states also use combined forms that include both an agent and treatment preferences. Others separate them. Read the form for your state carefully, because a document that works in one place may not be recognized elsewhere.

Health information and access

Medical providers may ask you to sign a separate authorization so that your agent can receive your health information. Federal privacy rules generally limit who can receive that information, and an authorization can make the agent's job easier. Some providers have their own forms, so ask what they need before you appoint someone.

Signing rules differ by state

The rules for making a healthcare directive valid are set by state law. Some states require witnesses, some require a notary, and some allow either. Some states restrict who can serve as a witness, for example by excluding the agent or people who would inherit from you. Because these requirements vary, using an official form for your state is often the safest starting point, and a lawyer can confirm the details.

Hospitals and nursing homes may also have policies about how they treat these documents. Ask your provider how they keep and review directives, and make sure your agent and doctor know where copies are.

Choosing an agent

Think about whether the person you have in mind can handle a stressful role. They may need to talk with doctors, understand medical options, and make decisions quickly. They should be willing to follow your wishes, even if they would personally choose differently. Many people also name a backup agent in case the first one cannot serve or is not reachable.

It helps to have a direct conversation with your chosen agent. Explain what matters most to you, what you fear, and what you would want to avoid. A written directive gives instructions, but the agent's understanding of your values often matters just as much.

Making changes

You can usually change or cancel a healthcare directive while you have the ability to make decisions. To do so, follow the rules for your state and let your doctors, your agent, and your family know about the change. Collect old copies or mark them as replaced, so that an outdated version is not used by mistake.

Review your documents after major life events, such as a marriage, divorce, move to another state, or change in health. A document prepared in one state may still be honored in another, but rules differ, so a lawyer can help check whether an update is needed.

Questions to ask before you sign

• Who should make medical decisions for me if I cannot?
• Do I want a backup agent?
• What treatments would I want or refuse in serious situations?
• Does my state require witnesses, a notary, or a specific form?
• Do my doctor and hospital have copies, and do they know my wishes?
• Would my agent need a separate authorization to receive my health information?

For general information about legal documents and how to find help, the USA.gov laws and legal issues page is a useful starting point. If you cannot afford a private lawyer, the USA.gov legal aid page lists programs that may help. You can also ask your doctor or hospital about advance care planning resources. Our estate planning practice page lists lawyers who handle these documents.

Frequently asked questions

Is a healthcare directive the same as a will? No. A will covers property after death. A healthcare directive covers medical decisions while you are alive, and it may apply when you cannot decide.

Does a living will mean I will be denied care? A living will describes your treatment preferences. It does not mean that all care stops. Its effect depends on how it is written and on your medical situation, so discuss the details with your doctor and a lawyer.

Can a doctor refuse to follow my directive? Providers generally must follow valid directives, but there can be exceptions, such as when a treatment is not available or conflicts with medical standards. Ask the provider how they handle these situations.

Do I need a new document if I move to another state? It depends. Some states honor documents from other states, while others have specific rules. A lawyer in your new state can tell you whether an update is advisable.

General information, not legal advice. Laws change and every case is different. Talk to a licensed attorney in your state about your situation.