What is the difference between an advance directive and a living will?

"Advance directive" is the broad term for legal documents that communicate your healthcare wishes when you can't communicate them yourself. A living will is one type of advance directive — specifically, the document that describes what medical treatments you do or don't want. A healthcare proxy (also called a durable power of attorney for healthcare or healthcare agent) is another type — it names a specific person to make medical decisions on your behalf. Most comprehensive advance directives include both components.

What is a DNR and how is it different from an advance directive?

A DNR (Do Not Resuscitate) order is a specific medical order, signed by a physician, instructing healthcare providers not to perform CPR if your heart stops or you stop breathing. It is a clinical document for your medical team. An advance directive is a personal legal document that expresses your wishes broadly. A DNR may reflect your wishes as expressed in your advance directive, but it's a separate document that your physician must sign. If you want a DNR, discuss it with your doctor and have them issue the order; including "no CPR" in your advance directive alone is not the same as having an active DNR order.

At what age should I create an advance directive?

Any adult over 18 should have an advance directive. The common assumption is that these documents are for the elderly or seriously ill — but serious medical situations can happen at any age. A 25-year-old in an accident, a 35-year-old with a sudden serious illness — these situations are uncommon but not rare, and they're exactly when advance directives matter most. Creating one while you're healthy means you can make these decisions thoughtfully rather than under pressure.

Does an advance directive expire?

In most states, advance directives do not expire — they remain valid until you revoke them or create a new one. However, it's good practice to review and update your advance directive every 3–5 years, or after any significant change in your health, your relationships (e.g., divorce from a healthcare proxy), or your values and preferences. When you update it, make sure to revoke old versions and distribute the new version to your healthcare providers, healthcare proxy, and family members.

What happens if I don't have an advance directive?

Without an advance directive, healthcare decisions default to whoever your state law designates as your surrogate decision-maker — typically a spouse, then adult children, then parents, then siblings, in that order. This person makes decisions based on their best guess of what you would want. This can create enormous conflict among family members, lead to decisions that don't reflect your actual wishes, and place an enormous burden on the people who love you most. Having an advance directive removes that burden and ensures your wishes are known and honored.

Advance Directive Explained: Living Will, Healthcare Proxy, and DNR

If you were in a serious accident and couldn't speak for yourself, who would make your medical decisions — and would they know what you actually want? An advance directive answers both questions in advance, while you're able to think clearly and without pressure.

What Is an Advance Directive?

An advance directive is a legal document (or set of documents) that communicates your healthcare wishes if you become unable to communicate them yourself — due to unconsciousness, severe injury, dementia, or other incapacitation.

Advance directives typically include two components:

A living will — describes what medical treatments you want or don't want in specific situations
A healthcare proxy (also called a durable power of attorney for healthcare or healthcare agent) — names a specific person to make medical decisions on your behalf

Some states combine these into a single document; others have separate forms. Some states have a specific form called a "Five Wishes" document that covers both.

The Living Will: What Treatments Do You Want?

A living will addresses specific medical situations and treatments. Common questions it covers:

Life-sustaining treatment

If you are in a terminal condition or permanent unconsciousness, do you want life-sustaining treatment continued, including artificial nutrition and hydration (feeding tubes and IV fluids)?

CPR (Cardiopulmonary Resuscitation)

CPR can restart a stopped heart — but success rates vary enormously by situation, age, and health status, and CPR can cause significant injury. Do you want CPR attempted in all circumstances? Only under certain conditions?

Mechanical ventilation

A ventilator breathes for you when you cannot breathe on your own. Short-term ventilation is common and often life-saving. Long-term ventilation to sustain life in a terminal or persistent vegetative state is a different situation. What are your wishes?

Artificial nutrition and hydration

When someone cannot eat or drink, feeding tubes and IV fluids can provide nutrition. This can sustain life but may not improve or reverse an underlying condition. What are your wishes in different scenarios?

Comfort care

Even if you decline certain aggressive treatments, you can and should specify that you want comfort care (palliative care, pain management, hospice) regardless. Declining life-sustaining treatment is not the same as declining all treatment.

The Healthcare Proxy: Who Makes Decisions?

A healthcare proxy (or healthcare power of attorney) names a specific person to make medical decisions for you when you cannot make them yourself. This person is called your healthcare agent, healthcare proxy, or patient advocate (terminology varies by state).

Choosing a healthcare agent

Your healthcare agent should be someone who:

Knows your values and wishes — The best agents can make decisions you'd endorse even in situations you didn't specifically anticipate.
Is emotionally able to advocate for you — Under significant stress, they need to be able to communicate with medical teams and, if necessary, disagree with what doctors recommend.
Is available and accessible — A medical crisis doesn't schedule itself. Your agent needs to be reachable.
Is willing to honor your wishes even if they disagree with them — This is critical. Your agent must be able to advocate for your wishes, not their own preferences.

Common choices: spouse or partner, an adult child, a sibling, a close friend. Do not assume someone will be comfortable in this role — have the conversation first and get their explicit agreement.

Have the conversation

Naming a healthcare agent is only as effective as the conversations you've had with them. Don't just hand them a document — talk with them about what matters to you, what you're afraid of, and what "quality of life" means to you. These conversations are hard and deeply worthwhile.

What Is a DNR?

A DNR (Do Not Resuscitate) is a physician's order — not an advance directive — instructing healthcare providers not to perform CPR if your heart stops or you stop breathing. It must be signed by your doctor and placed in your medical record to be effective.

If you want a DNR, discuss it with your physician and ensure the order is in your medical record at any facility where you receive care. Simply having a "no CPR" preference in your advance directive is not the same as an active DNR order — medical staff respond to physician orders, not patient documents alone.

In many states, POLST (Physician Orders for Life-Sustaining Treatment) forms serve a similar function and are broader than DNRs — they address CPR, artificial ventilation, artificial nutrition, and hospitalization preferences.

How to Create an Advance Directive

Step 1: Get your state's forms

Advance directive requirements vary by state. Use your state's official forms, available from:

Your state's department of health website
CaringInfo.org (National Hospice and Palliative Care Organization) — free state-specific forms
Your physician's office
A hospital social worker

Step 2: Think through your values and wishes

Before filling out forms, spend time thinking about:

What does quality of life mean to you?
What would make life not worth living for you (what conditions would you not want to be kept alive in)?
What matters most to you in your final days or weeks?
Where do you want to die, if you have a choice?

Step 3: Complete and sign the forms

Most states require witnesses and/or notarization. Witnesses typically cannot be family members, heirs, or healthcare providers. Follow your state's requirements exactly.

Step 4: Distribute copies

Give copies to:

Your healthcare agent
Your primary care physician (ask them to put it in your medical record)
Any specialist physicians
Any hospital where you receive regular care
Family members who might be involved in your care
Store the original in a secure, accessible place — and tell people where it is

Step 5: Review and update periodically

Review your advance directive every few years or after any major change in health, relationships, or values. Revoke old versions when you create new ones.

Talking to Your Family

An advance directive without a family conversation can still create conflict. Tell your family:

That you have an advance directive and where it's kept
Who your healthcare agent is
The key decisions you've made and why

This conversation is difficult. It is also one of the greatest gifts you can give the people who love you — clarity instead of guesswork, and freedom from having to make impossible decisions without guidance.