Creating Your Own Living Will and Health Care Directive
Learn how to prepare a legally effective living will and health care directive on your own, from reflection to signing and sharing.
A living will and health care directive allow you to decide in advance what medical care you want if you cannot speak for yourself. These documents protect your wishes, guide your loved ones, and help your medical team honor your values when you are seriously ill or injured.
Understanding What a Living Will and Health Care Directive Do
Before you start drafting anything, it helps to understand the basic concepts and how they work together in practice.
Key Terms You Should Know
- Advance directive: An umbrella term for written instructions about your future health care that take effect only if you cannot communicate your own decisions.
- Living will: A legal document describing what medical treatments you do or do not want in specific serious health situations, such as terminal illness or permanent unconsciousness.
- Health care proxy / agent: The person you authorize to make medical decisions for you when you are unable to decide or communicate.
- Durable power of attorney for health care: The legal instrument that appoints your health care agent and defines that person’s authority.
- Do-not-resuscitate (DNR) order: A medical order telling health professionals not to attempt cardiopulmonary resuscitation (CPR) if your heart or breathing stop.
- POLST (Physician Orders for Life-Sustaining Treatment): A doctor-signed medical order used mainly by people with serious illness to state which emergency treatments they do or do not want.
How These Documents Work Together
In many states, you can use a single form that combines a living will and a health care power of attorney, often called an advance health care directive or similar name. Even when they are separate documents, they serve complementary roles:
- The living will records your treatment preferences.
- The health care power of attorney authorizes a trusted person to apply those preferences in real situations.
Doctors generally rely on these documents only after they determine you cannot make or communicate informed medical choices, and when your condition meets the legal criteria in your state (such as terminal illness or persistent unconsciousness).
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Planning Before You Put Anything in Writing
Creating a living will is not simply filling out a form. It starts with careful reflection about your values and conversations with people you trust.
Clarify Your Goals and Values
Ask yourself what matters most if you were to become severely ill or gravely injured. Many people find it useful to write down thoughts in a notebook first. Consider:
- How you define an acceptable quality of life (for example, being able to recognize family, make decisions, or live without constant severe pain).
- How you feel about being kept alive by machines if your chances of meaningful recovery are very low.
- Whether extending life as long as possible is more important than avoiding intensive medical interventions.
- Any religious or cultural beliefs you want respected in end-of-life care.
Talk with Your Health Care Professional
A doctor, nurse practitioner, or other health professional can help you understand what medical options are likely to come up and what they involve. Reputable organizations like the National Institute on Aging encourage people to discuss emergency treatments, chronic illness, and end-of-life care with clinicians as part of advance care planning.
Topics to review may include:
- Cardiopulmonary resuscitation (CPR) and its risks and benefits for people of your age and health status.
- Use of a breathing machine (mechanical ventilation) when lungs fail.
- Artificial nutrition and hydration through feeding tubes or IV lines.
- Pain control, sedation, and comfort-focused care (palliative and hospice services).
Choose a Health Care Agent
Most experts strongly recommend appointing a health care proxy, even if you also have a detailed living will. Someone you trust can address situations you did not foresee.
Good candidates usually:
- Understand your values and are willing to follow your wishes, even if other relatives disagree.
- Can stay calm and make decisions under stress.
- Are likely to be reachable quickly in an emergency.
- Are adults who meet any legal requirements in your state.
Using the Right Forms for Your State
Every U.S. state has its own laws about advance directives, including specific requirements for witnesses, notarization, and default wording. To create a document that is valid where you live, start with an appropriate template.
Where to Find State-Specific Forms
- State-sponsored or nonprofit resources: Organizations such as CaringInfo provide free advance directive forms for each state, with instructions.
- Health system or local government websites: Many hospitals and county health departments post downloadable advance directive and health care proxy forms.
- National nonprofits and legal aid groups: Cancer support organizations and senior advocacy groups often share state-approved forms for people with serious illness.[10]
Using an official or widely recognized form increases the likelihood that health professionals will be familiar with it and that it will meet statutory requirements.
Check the Legal Requirements in Your State
Before you begin filling out a form, verify:
- Minimum age and competency requirements for signing.
- Number of witnesses required and who may serve (for example, some states bar relatives, heirs, or your chosen agent from being witnesses).
- Whether notarization is required or optional.
- Any special rules for pregnant patients or specific treatments.
State instructions included with official forms usually summarize these points in clear language.
Drafting Your Living Will: Issues to Address
Once you have a suitable form, you can start making specific choices. Even when a template offers checkboxes, it is wise to read every section and add clarifying language when permitted.
Conditions That Trigger Your Living Will
Most living will statutes only apply when you have a serious medical condition and cannot make or communicate your own decisions. Common legal triggers include:
- A terminal illness that will result in death despite medical treatment.
- Irreversible unconsciousness, such as a persistent vegetative state.
- Advanced, permanent loss of decision-making capacity, as defined by your state law.
Some forms allow you to broaden or narrow these conditions. Be honest about when you want aggressive treatment and when you would prefer comfort-focused care.
Life-Sustaining Treatments to Consider
Federal and state guidance often highlight several categories of treatment commonly addressed in living wills. You may wish to state whether you want these treatments attempted, withheld, or limited.
| Treatment or Intervention | What It Is | Issues to Consider |
|---|---|---|
| CPR (Cardiopulmonary Resuscitation) | Chest compressions, shocks, and related efforts to restart the heart and breathing. | Can cause broken ribs or brain injury; success rates are lower in frail or chronically ill patients. |
| Mechanical Ventilation | A machine moves air into and out of your lungs through a breathing tube. | You may be sedated and unable to speak; consider whether you want a trial period versus long-term use. |
| Artificial Nutrition and Hydration | Feeding tubes or IV fluids provide food and water when you cannot eat or drink. | Can prolong life but also extend the dying process in some conditions; may cause complications like infections. |
| Dialysis | A machine filters waste products from the blood when kidneys fail. | Requires frequent treatments; consider whether you would want it if overall prognosis is very poor. |
| Major Surgery or Intensive Care | Operations and invasive procedures aimed at prolonging life in critical illness. | Ask how likely they are to restore meaningful function versus prolong suffering. |
Comfort Care and Pain Relief
Most people want to receive pain medication and other comfort measures even when they decline life-prolonging treatments. Reputable medical organizations stress that good palliative care can relieve pain and other symptoms while respecting your treatment choices.
In your living will, you can typically state that you:
- Want medicines and treatments to relieve pain and shortness of breath, even if they might unintentionally shorten life.
- Prefer hospice care at home or in a dedicated facility if you meet eligibility criteria.
- Wish to avoid procedures that only increase discomfort without improving quality of life.
Additional Personal Wishes
Many forms include space for extra instructions. You might use that to address:
- Spiritual or religious practices you want accommodated.
- Preferences about organ and tissue donation, which may also require separate authorization forms.
- People you do or do not want involved in discussions with your doctors.
- Any specific facility or type of care setting you prefer, if options are available.
Appointing and Instructing Your Health Care Agent
If you choose to name a health care proxy, you will typically complete a section within the advance directive or a stand-alone durable power of attorney for health care.
Defining Your Agent’s Authority
Most standard forms authorize your agent to make virtually any health care decision you could make for yourself, subject to limits you specify. You may choose to:
- Allow your agent to consent to, refuse, or stop treatments consistent with your wishes.
- Permit decisions about hospital admission, nursing facilities, hospice enrollment, and home care services.
- Authorize access to your medical records so the agent can make informed choices.
- Give guidance on when your agent should follow the written living will versus exercise independent judgment.
Talk Openly with Your Agent
Completing the form is only the beginning. To prepare your agent:
- Share your written documents and walk through each major choice.
- Explain what quality of life means to you and what outcomes you would consider unacceptable.
- Encourage questions so your agent fully understands your preferences.
- Tell your family and close friends whom you have chosen and why, to reduce potential conflict later.
Signing, Witnessing, and Storing Your Documents
For your living will and health care directive to be legally effective, you must sign them correctly and ensure they are available when needed.
Execution Requirements
While the details vary from state to state, common steps include:
- Signing the document when you are of sound mind and acting voluntarily.
- Having the required number of adult witnesses sign, making sure they meet any eligibility rules.
- Having the document notarized if your state’s law or form requires or recommends it.
Follow the instructions that come with your form carefully. If anything is unclear, many people contact a local legal aid office, bar association, or hospital social worker for clarification.
Where and How to Store Your Advance Directive
Once executed, your documents should be easy to find in an emergency. The National Institute on Aging and major health systems advise the following practices:
- Give copies to your health care agent and any alternate agents.
- Provide a copy to your primary care clinician and any key specialists, and ask that it be placed in your medical record.
- Keep a copy in a visible but safe place at home (not in a locked safe deposit box).
- Carry a card in your wallet stating that you have an advance directive and how to obtain it.
When and How to Update Your Living Will
Advance care planning is an ongoing process, not a one-time task. Medical guidelines recommend reviewing your documents periodically, particularly after major life changes.
Times You Should Revisit Your Directive
- New diagnosis of a serious or life-limiting illness.
- Significant change in health, such as major surgery, injury, or progression of chronic disease.
- Change in relationships, including marriage, divorce, or the death of your chosen agent.
- Relocation to another state, where laws and standard forms may differ.
When you update your documents, destroy obviously outdated versions and send new copies to your agents and health care team so everyone is relying on the current directive.
Frequently Asked Questions About Doing a Living Will Yourself
Do I need a lawyer to make a valid living will?
In most states, you can complete a living will and health care directive on your own by using a state-appropriate form and carefully following the instructions. However, you may wish to consult a lawyer if you have complex family situations, own substantial assets, or simply want professional review.
Is a handwritten statement about my wishes legally binding?
Some states allow any clear written expression of your wishes to be considered, but documents that do not meet statutory formalities may provide less legal protection for health care providers and may be harder to enforce. Using your state’s approved form, or a widely recognized equivalent, usually offers stronger legal standing.
What happens if I do not have a living will or health care proxy?
If you become unable to decide for yourself and have no advance directive, state law typically identifies who may act as your default decision-maker (for example, a spouse, adult child, or other relative). This may not reflect your preferences and can sometimes lead to family conflict, which is why many experts urge adults of all ages to complete advance directives.
Can I still get a DNR order without a living will?
Yes. A DNR or do-not-intubate (DNI) order is a medical order written by a clinician and can be requested directly, even if you have not completed an advance directive. However, including your preferences about resuscitation in your living will helps ensure consistency across your records and decisions.
Will my living will be honored if I travel to another state?
Many states will honor out-of-state advance directives that were validly executed where you signed them, but the exact rules vary. Keeping your instructions clear and naming a health care agent increases the likelihood that your wishes will be respected wherever you are.
References
- Advance Care Planning: Advance Directives for Health Care — National Institute on Aging, U.S. Department of Health and Human Services. 2023-03-24. https://www.nia.nih.gov/health/advance-care-planning/advance-care-planning-advance-directives-health-care
- Living wills and advance directives for medical decisions — Mayo Clinic. 2023-08-25. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303
- Advance Directive — UCLA Health. 2022-06-01. https://www.uclahealth.org/patient-resources/support-information/advance-directive
- Types of Advance Health Care Directives — American Cancer Society. 2022-01-20. https://www.cancer.org/cancer/managing-cancer/making-treatment-decisions/advance-directives/types-of-advance-health-care-directives.html
- Find your State’s Advance Directive — CaringInfo, National Hospice and Palliative Care Organization. 2023-05-10. https://www.caringinfo.org/planning/advance-directives/by-state/
- Advance Health Care Directive Form (California) — Trinity County Health and Human Services. 2011-01-01. https://www.trinitycounty.ca.gov/DocumentCenter/View/251/Advanced-Health-Care-Directive-Form-fillable-PDF
- Free Advance Directive Forms by State — AARP. 2022-09-15. https://www.aarp.org/caregiving/financial-legal/free-printable-advance-directives/
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