Advance directive / living will

An advance directive (also called a living will or advance healthcare directive) is a legal document that communicates your wishes about medical treatment if you become unable to speak for yourself. It typically combines two components: a living will (specifying which treatments you do or do not want) and a healthcare proxy/power of attorney (naming someone to make medical decisions on your behalf).

26 steps across 4 sections

1. What Decisions It Covers

  • Life support / mechanical ventilation Whether you want to be placed on a ventilator if you cannot breathe on your own.
  • CPR / resuscitation Whether you want cardiopulmonary resuscitation if your heart or breathing stops.
  • Feeding tubes / artificial nutrition and hydration Whether you want a tube to deliver food and water if you cannot eat or drink.
  • Dialysis Whether you want kidney dialysis if your kidneys fail.
  • Antibiotics / aggressive infection treatment Whether you want antibiotics for life-threatening infections in a terminal or irreversible condition.
  • Pain management / palliative care Preferences for comfort care, including medications for pain relief even if they may hasten death.
  • Organ and tissue donation Whether you wish to be a donor.
  • Blood transfusions Whether you accept blood products.
  • Diagnostic tests and surgical procedures Preferences for invasive procedures when prognosis is poor.

2. State-Specific Forms

  • Witness requirements Most states require two witnesses; some prohibit witnesses who are related, who would inherit from you, or who are healthcare providers.
  • Notarization Some states require notarization in addition to or instead of witnesses (e.g., North Carolina, Missouri).
  • Combined vs. separate forms Some states combine the living will and healthcare proxy into one document; others have separate forms.
  • Specific language requirements A few states require specific statutory language to be included.
  • CaringInfo (National Hospice and Palliative Care Organization): Free downloadable forms for all 50 states and U.S. territories at caringinfo.org.
  • AARP Free printable advance directive forms by state.
  • State Attorney General's Office Often provides official forms.
  • Local Area Agency on Aging Call the Eldercare Locator at 800-677-1116.

3. Five Wishes Document

  • Wish 1: The person I want to make care decisions for me when I can't (healthcare agent).
  • Wish 2: The kind of medical treatment I want or don't want.
  • Wish 3: How comfortable I want to be (pain management, bathing, music, etc.).
  • Wish 4: How I want people to treat me (dignity, privacy, prayers, presence of loved ones).
  • Wish 5: What I want my loved ones to know (forgiveness, personal messages, final wishes).

4. Registration

  • U.S. Living Will Registry (uslivingwillregistry.com): National electronic registry; stores your document and makes it available to healthcare providers 24/7.
  • State registries States like California, Idaho, Montana, Nevada, and others maintain official registries.
  • MyDirectives.com Free digital platform for creating, storing, and sharing advance directives.
  • Hospital/provider systems Many health systems can scan your directive into your electronic medical record.

Common Mistakes

  • Not having one at all
  • Using a form from the wrong state
  • Being too vague
  • Not discussing wishes with family and healthcare agent
  • Storing it where no one can find it

Pro Tips

  • Start the conversation, not the paperwork
  • Be specific about scenarios
  • Name a backup agent
  • Use the "Five Wishes" approach even if you use your state form
  • Carry a wallet card

Sources

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