Advance directives are end-of-life planning documents that establish your healthcare wishes if you’re incapacitated and can’t make your own decisions.
You can use an advance directive to explain to medical professionals what treatment you want to receive in an emergency or if you can’t speak for yourself. You can also use them to ensure loved ones make the right medical decisions on your behalf.
- Advance Directive Forms - By State
- What Is an Advance Directive?
- What Is Included in an Advance Directive?
- Who Needs an Advance Directive?
- Does an Advance Directive Guarantee Your Wishes?
- How to Get an Advance Directive
- How to Use Your Advance Directive
- What Happens If You Don't Use an Advance Directive?
- Advance Directive Sample
Advance Directive Forms – By State
Click to expand the table and find your state’s advance directive forms and requirements.
| State & Laws: | Advance Directive Forms: | Execution Requirements: |
|---|---|---|
|
Alabama AL Code § 22-8A-4 |
Alabama Advance Directive for Health Care (Word, PDF) | Two witnesses or notarization |
|
Alaska AK Stat § 13.52.010 |
Advance Health Care Directive:
|
Two witnesses or notarization |
|
Arizona AZ Rev Stat § 36-3221 |
Arizona Living Will (Word) Arizona Health Care Power of Attorney (Word, PDF) |
At least one witness or notarization |
|
Arkansas AR Code § 20-6-103-c |
Arkansas Living Will (Word) Arkansas Durable Power of Attorney for Health Care (Word, PDF) |
Two witnesses or notarization |
What Is an Advance Directive?
An advance directive or an advance healthcare directive is a legal document that tells healthcare professionals and loved ones what medical treatment you want (or don’t want) to receive if you’re dying or unconscious and can’t communicate your desires for future medical care.
Because laws vary across the U.S., each state has its format and definition for advance directives. Depending on where you live, you may need a single form or a combination of forms to express your wishes.
If you fall into a coma, develop dementia, become terminally ill, or obtain a debilitating injury, an advance directive can help ensure your wishes regarding the following healthcare choices:
- Palliative and comfort care: Managing pain to improve your quality of life.
- Ventilation: Using a ventilator to keep you breathing
- Tube feeding: Receiving nutrition through a tube or IV
- Resuscitation: Receiving CPR to resuscitate you if your breathing or heartbeat stops
- Organ donation: Donating your organs after death
What Is Included in an Advance Directive?
An advance directive is a broad term for a document that dictates your healthcare decisions.
The following individual forms are examples of different types of advance directives. Your state may have one hybrid document that includes several of these forms, or you may need to fill them out separately.
1. Living Will
A living will is a document that explains your treatment decisions if you fall into a coma or are unresponsive (such as how to prolong your life or manage pain). It usually occurs when there’s a low chance of recovery [1] .
You write this form while you’re still able to communicate your wishes. Healthcare professionals will try to follow it as closely as possible if you become incapacitated.
One difference between an advance directive and a living will is that, in some states, the living will is a standalone document. And in other states, it’s part of an advance directive.
Read More: Advance Directive vs. Living Will: What’s the Difference?
2. Medical Power of Attorney (MPOA)
A medical power of attorney form lets you appoint an “agent” or “attorney-in-fact” to make medical decisions on your behalf if you cannot.
The living will part of an advance directive concerns the treatment you want, but a health care power of attorney gives someone the authority to make additional decisions for you. An MPOA can be helpful if a complex medical situation arises and you aren’t able to state your preferences beforehand.
3. Do Not Resuscitate (DNR)
A do not resuscitate (DNR) form may be part of an advance directive. It tells healthcare providers to withhold life-sustaining treatment and not try to keep you alive.
For example, you may request that emergency medical personnel not use cardiopulmonary resuscitation (CPR) or an automated external defibrillator (AED) to keep blood flowing to your brain or restart your heart.
Other End-of-Life Forms
As you’re participating in advance care planning, you can explore other end-of-life forms to increase the chances of your wishes being fulfilled after your passing.
Who Needs an Advance Directive?
Anyone who wants to control and have peace of mind over their future healthcare decisions can benefit from creating an advance directive. This document can alleviate stress and confusion among healthcare professionals and your loved ones.
Consider creating an advance healthcare directive if you are:
- Over the age of 18
- Military personnel going to serve overseas
- Pregnant
- Traveling abroad for a more extended period
- Undergoing surgery, however minor or routine it is
- Entering the hospital for any reason
- Diagnosed with a terminal illness
- Undergoing continuous medical treatment
- Concerned about your overall health
- Engaged in a high-risk profession
- Engaged in extreme sports or other activities that put my health at risk
As long as you’re 18, you’re never too young or healthy to create an advance directive.
Does an Advance Directive Guarantee Your Wishes?
Not always. Your medical team and your attorney-in-fact will do their best to respect your wishes. However, it may not always be possible. You may be in a complex or unforeseen medical situation that requires your healthcare team to take a different approach than what you outlined in your advance directive.
If your advance directive wishes to go against generally accepted medical practices, the institution’s protocols, or the healthcare provider’s conscience, you may receive medical care other than what you requested.
Note that federal law protects patients’ right to self-determination when possible through the 1990 Patient Self-Determination Act [2] .
How to Get an Advance Directive
Step 1 – Make Your Declaration
The first part of an advance directive is the declaration. Fill out your name to declare that the document explains your wishes if you can’t speak for yourself. Confirm you’re currently of sound mind and legal age.
Review the definitions of medical terms and phrases the document will use. This will help you ensure you understand the powers you’re granting and the decisions you’re making.
Step 2 – Assign Medical Power of Attorney
Whether you’re filling out a hybrid advance directive form or separate ones, you must assign medical power of attorney as part of your advance directive and choose an agent to act on your behalf.
On this part of the advance directive form, please fill out your agent’s contact information and make additional comments about which powers you do or don’t want them to have. Ensure your appointed healthcare agent is someone you can trust, such as a family member, as they must make crucial decisions in times of great stress, sadness, and uncertainty.
Step 3 – Complete Your Living Will
On the living will part of the advance directive, initial your preferences next to the healthcare you want to receive if you are diagnosed with a terminal condition or fall into a permanently unconscious state.
You’ll need to choose whether you wish to receive life-sustaining treatments, artificial nutrition, and hydration. You may indicate if you prefer your agent to decide based on the circumstances.
You can also state your preference regarding relief from pain and any other wishes.
Step 4 – Decide on Organ Donation
You can choose whether to donate your organs in the event of your death and, if you do, for what purpose (such as therapy, transplant, research, or education).
You can also state that you do not wish to donate your organs or authorize your agent to decide.
Step 5 – Choose Your Final Arrangements
Many advance directives allow you to detail what arrangements you want in place upon your death, such as if you want your body to be interred or cremated. You can also indicate that you want your agent to handle these arrangements.
Step 6 – Name Your Primary Physician
Provide your primary physician’s name, address, and telephone number. Naming a primary physician can help ensure someone familiar with your situation promotes continuity with your care.
Step 7 – Sign Your Name
After completing all sections of your advance directive form, sign your name. Depending on your state’s execution requirements, you may also need signatures from your agent, several witnesses, and a notary public to legally bind the form.
How to Use Your Advance Directive
After completing your advance directive form, store it in a safe place, such as a safety deposit box. You should also notify your healthcare provider and provide copies to your agent, primary care physician, hospital, trusted individuals, and anyone named in the directive.
Once you’ve created an advance directive, it isn’t set in stone. Your opinions and values regarding future healthcare needs could change, so you can modify your plans to reflect these changes. You must complete a new advance directive to reflect the changes and meet the proper signing or notarization requirements.
The Five D’s of Updating Your Directive
You should reassess and consider changes to your advance healthcare directive anytime one of the following “Five Ds” occurs:
| Diagnosis | When you are diagnosed with a serious or grave health condition |
| Decline | When you experience a significant deterioration or decline in health |
| Death | Whenever you experience the passing of a loved one |
| Divorce | When you experience a divorce or other significant family change |
| Decade | When you enter a new decade of your life |
What Happens If You Don’t Use an Advance Directive?
While no states require individuals to have advance directives, you may face severe consequences without one. Consider some of the consequences of not having an advance directive:
- Confusion amongst family members regarding your healthcare wishes
- Emotional distress for your family members
- Substantial healthcare maintenance costs
- Your organs and tissues not being donated when you wanted them to be donated
- Unnecessary, unwanted, prolonged, or painful treatment, whether it be life-extending treatment, mental health treatment, or another type
Benefits of Advance Directives
- The right to self-determination
- A high quality of life
- Less pressure and confusion for loved ones
- Clarity about your healthcare preferences
Advance Directive Sample
Download an advance directive form in PDF or Word format:
