If you’re concerned about end-of-life care or medical decisions family members might make on your behalf if you’re unable to speak for yourself, an advance directive can offer some much-needed peace of mind.
It’s a legally recognized document that details the treatments you do and don’t want so that doctors and loved ones will know and honor your wishes. We’ll break down the basic steps to create some of the most popular forms of healthcare directives.
Key Takeaways
The steps to complete an advance directive depend on the type of directive you’re creating and the state where you live.
A living will and healthcare power of attorney are written advance directives that often need to be signed, witnessed, and notarized.
Do-not-resuscitate, do-not-intubate, or full code directives can be communicated verbally or included in your living will.
What Is an Advance Directive, and Why Is It Important?
An advance directive is a legal document patients use to communicate their medical wishes to care providers. They specify the types of treatments they do or do not want in the future.
For example, perhaps you feel strongly against intubation and don’t want to be fed using a tube if such a situation ever arises. By spelling out those feelings in an advance directive, doctors and loved ones will know to avoid intubation if something unexpected happens and you’re unable to communicate your wishes in the future.
As a result, an advance directive can be a critical component of your overall healthcare plan for the future to ensure your treatment wishes are honored.
Under the U.S. Patient Self-Determination Act, medical staff are required to do their best to honor the instructions in your directive. But exceptions could be made if your wishes violate:
Your doctor’s conscience.
Your healthcare provider’s policies.
Healthcare standards.
There are several different types of advance directives. The most common are:
A living will: This is a legal document that stipulates your medical wishes in writing.
A healthcare power of attorney: This is a legal document that appoints a healthcare agent to make medical decisions on your behalf if you’re incapacitated or unable to make your own decisions in the future.
A do-not-resuscitate (“DNR”) or do-not-intubate (“DNI”) order: These directives stipulate a patient’s wishes surrounding CPR and intubation.
A full code directive: This directive communicates a patient’s wishes for doctors to use all means of resuscitation if required.
How Do You Complete an Advance Directive?
The requirements and format of each advance directive vary depending on the type of directive you opt for and the state in which you create your directive.
Because of these variables, it’s often worth consulting your attorney or estate planner before completing your advance directive. This will ensure you fully understand the requirements in your state so you end up with a valid directive.
To help you get started, we’ll run through the general steps and requirements you can expect when completing an advance directive.
Completing a Living Will
A living will tells your doctors how you want to be treated if (and when) you’re unable to make your own choices or communicate your wishes. A living will can be as specific as you want it to be, allowing you to list out treatments you refuse to get in particular situations.
To create a living will, you’ll generally be expected to take these steps:
Talk to your doctor. Your living will should start with a conversation with your medical provider to determine which potential medical decisions might arise in the future and whether your wishes could be carried out. If you’re eligible for Medicare, advance care planning is covered.
Make your decisions and communicate them to your loved ones. After you reflect on your conversation with your doctor, make the decisions you’d like put into your living will. Make sure you talk to loved ones about those decisions to avoid confusion if you’re unable to talk to them about it if something unexpected happens.
Complete a living will form. Each state provides a different living will form that you can find online and download for free.
Get your will signed, notarized, and witnessed. Be sure to check the requirements in your state of residence, because rules on who can witness an advance directive and whether it needs to be notarized vary.
Alana Gibson, chief operating officer at DGR Legal in Morris Plains, New Jersey, explains: “Witnesses confirm the document's authenticity and the signatory's intention under their free will, safeguarding against potential disputes.
"The rules around who can lawfully witness an advance directive vary by state but generally exclude individuals who stand to benefit from the person's death, such as heirs or healthcare providers directly involved in their care.”
Once your directive is signed, witnessed, and notarized (if required), store your living will in a safe place. You should also provide a copy to your doctor and any legal proxies you might have.
This is where Trustworthy's Family Operating System® can offer unrivaled support.
Trustworthy is an intelligent digital vault that enables you to upload important family documents like a healthcare power of attorney or living will. Trustworthy then creates a digital, encrypted copy that you can update as required and securely share with your attorney, family members, friends, doctor, or healthcare agent.
Completing a Healthcare Power of Attorney
A healthcare power of attorney is a legal document that appoints someone you trust to be your agent in the event that you cannot make your own medical decisions in the future.
If you’re unable to communicate your wishes, that individual is authorized to talk to doctors about your medical treatment and make choices on your behalf.
It’s possible to create a healthcare power of attorney on your own. However, in some cases, it might be faster and simpler to ask your attorney to support you.
David Brilliant, founder of Brilliant Law Firm in Walnut Creek, California, says: “Creating an advance directive often does not legally require an attorney, but consulting one can be beneficial to ensure that all legal requirements are met and your wishes are clearly articulated. …
“For instance, I've assisted clients in drafting complex directives that address specific wishes not only about life-sustaining treatment but also about their personal values and beliefs concerning their care, making the document both a legal and personal reflection of their wishes.”
To create a power of attorney, you must:
Choose your agent. Select your appointed healthcare agent carefully, and make sure you have an honest and open conversation with them about this appointment and what it entails.
Choose which healthcare decisions your agent can make on your behalf.
Complete a healthcare power of attorney form. State governments and nonprofits generally offer power of attorney templates you can customize and complete. Alternatively, your attorney can help you to create a power of attorney form from scratch.
Get your power of attorney signed, witnessed, and notarized. Most states require a power of attorney form to be notarized, although the rules on who can witness a power of attorney vary by state.
After your power of attorney is validated, it’s important to provide copies to all relevant parties.
That normally means giving a copy to your doctor, lawyer, estate planner, and loved ones. It’s also crucial to keep a copy stored securely to ensure easy access in case you need to make amends or provide a copy to someone else.
Trustworthy makes it easy to safely store and share copies of your power of attorney.
Ready to learn more? Discover Trustworthy’s range of features and find out how it can support your healthcare planning.
Completing a DNR, DNI, or Full Code Order
Do-not-resuscitate (“DNR”) orders and do-not-intubate (“DNI”) orders are slightly less complicated.
A DNR order tells healthcare providers that you do not want to be resuscitated under any circumstances if you stop breathing or your heart stops beating. Meanwhile, a DNI order says it’s OK to perform CPR on you, but you refuse to be intubated.
By contrast, a full-code directive gives doctors permission to use any form of resuscitation to revive you.
It’s possible to include a DNR, DNI, or full code order as a stipulation within your living will. But you can normally communicate this directive verbally to your doctor.
As long as you’re deemed to be of sound mind when you give the instruction, your doctor should update your medical records accordingly. Depending on the state or healthcare institution, you may be required to complete a short form with your doctor.
Like the other types of advance directives we’ve discussed, it’s critical that you communicate these wishes to loved ones. This avoids any confusion about your wishes in the future and ensures they’ll be honored.
Frequently Asked Questions
Is an Advance Directive Legally Binding?
No. Under the Patient Self Determination Act, doctors are legally required to do their best to honor your wishes. But in some cases, it might not be possible to execute those wishes precisely.
Can an Advance Directive Be Verbal?
In some cases, yes. A do-not-resuscitate order, do-not-intubate order, or full-code directive can generally be made verbally. A living will or power of attorney will normally need to be written and signed.
What Is the Most Common Written Advance Directive?
The two most common types of written advance directives are a living will and a healthcare power of attorney.
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