All About Advance Care Planning (Updated October 2025)

Planning for the worst-case scenario is never easy. It's the kind of thing most of us push to the back of our minds, telling ourselves we'll get to it later. But here's the reality: a medical crisis can happen at any age. A car accident, a sudden illness, a complication during surgery—any of these could leave you unable to make your own healthcare decisions. And when that happens, someone else will be making those decisions for you.

Advance care planning gives you the power to make your wishes known now, so your care aligns with your values later. It's not about giving up or being pessimistic. It's about taking control of your healthcare journey, even during the moments when you can't speak for yourself. This isn't just paperwork—it's peace of mind for you and the people who love you.

The healthcare system wasn't designed with patients in mind. It's confusing, overwhelming, and often makes things harder than they need to be. But advance care planning cuts through that chaos. It gives you a voice, protects your autonomy, and ensures the people making decisions on your behalf know exactly what you want. Whether you're 25 or 85, healthy or managing chronic illness, this planning matters.

What Is Advance Care Planning?

Advance care planning is the process of thinking through, documenting, and communicating your healthcare preferences before a medical crisis happens. It involves making decisions about the types of medical treatments you would or wouldn't want if you became too sick or injured to speak for yourself.

These decisions get written down in legal documents called advance directives, which only take effect if you're incapacitated. Think of them as instructions for your medical team and your loved ones—clear guidance about what matters most to you when you can't say it yourself.

But advance care planning is more than just signing forms. It's an ongoing conversation with the people in your life. It's about reflecting on your values, thinking through different scenarios, and making sure your healthcare proxy and family members truly understand what you want. Your preferences might change as you age, as your health changes, or as medical technology advances. That's normal. The key is starting the process and keeping it current.

Why Advance Care Planning Matters

Without advance directives, the people who love you most will be left guessing about what you would have wanted. They'll face impossible decisions during an already devastating time, and they might not all agree. Doctors will follow standard protocols, which may or may not align with your personal values. And the system will keep moving forward, with or without input that reflects who you are and what you believe.

The numbers tell a stark story. According to research published in the Journal of Palliative Medicine, patients with documented advance care plans are more likely to receive care that matches their preferences, experience less aggressive end-of-life treatment when they don't want it, and their families report less stress and anxiety during critical moments.

When you don't plan ahead, the default setting in American healthcare is "do everything." That means every possible intervention, every life-sustaining measure, regardless of quality of life or chances of recovery. For some people, that's exactly what they want. For others, it's not. The only way to ensure you get the care you actually want is to spell it out clearly, in advance.

Advance care planning also protects your loved ones from the burden of guessing. When family members know your wishes, they can advocate for you with confidence. They're not left wondering if they made the right choice. They're simply honoring what you already decided. That clarity is a gift during one of life's hardest moments.

Who Needs Advance Care Planning?

Everyone. Full stop.

Yes, advance care planning becomes even more important as you age or if you're diagnosed with a serious illness. But the truth is, none of us know when we might need these documents. A 30-year-old in perfect health could be in a car accident tomorrow. A woman in her 40s could have an unexpected medical crisis during childbirth. A person with a chronic condition could suddenly face a decision about aggressive treatment.

If you're a young, healthy adult, you might think you don't need to worry about this yet. But unexpected accidents and illnesses happen every day. If you're managing a chronic condition, advance care planning helps you stay in control as your health changes. If you're an aging adult, this planning becomes essential—not just for end-of-life care, but for any medical emergency where you might not be able to communicate.

Certain life events should trigger advance care planning conversations:

You've recently turned 18. Once you're a legal adult, your parents no longer automatically have the right to make medical decisions for you. If something happens and you're incapacitated, doctors need to know who you want making those choices.

You're getting married or having a baby. Major life changes are a good time to think about who you want as your healthcare proxy and what your wishes are for different scenarios.

You've been diagnosed with a serious illness. Whether it's cancer, heart disease, or another chronic condition, diagnosis is the right time to think through your treatment preferences and quality of life goals.

You're starting to think about retirement or aging. As you plan for your financial future, plan for your health future too. What kind of care do you want as you age? Where do you want to receive it?

The bottom line: if you're an adult with the capacity to make decisions, you should have advance directives. It's one of the most important things you can do for yourself and the people who care about you.

Understanding Your Advance Care Planning Documents

Advance care planning involves several different documents, and each one serves a specific purpose. Understanding what they do—and how they work together—helps you make informed decisions about what you need.

Living Will (Advance Healthcare Directive)

A living will, sometimes called an advance healthcare directive, is a written statement of your medical wishes. It tells your doctors what treatments you would want, which ones you wouldn't want, and under what conditions each decision applies.

This document only takes effect when you can't communicate your wishes yourself—if you're unconscious, severely injured, or otherwise unable to speak for yourself. As long as you can talk to your doctors and make decisions, your living will stays in the background.

A living will lets you address specific medical scenarios. You can specify whether you want CPR if your heart stops, whether you want to be on a ventilator if you can't breathe on your own, whether you want artificial nutrition through feeding tubes, and many other treatment decisions. You can also provide broader guidance about your values and what quality of life means to you.

The level of detail is up to you. Some people write very specific instructions for different situations. Others provide general guidance and trust their healthcare team and proxy to make specific decisions based on those principles. There's no single right way to do it—the important thing is that your wishes are clear enough to guide the people making decisions on your behalf.

One key point: a living will is not a DNR order (do not resuscitate). A DNR is a specific medical order that tells emergency medical personnel not to perform CPR if your heart stops or you stop breathing. We'll talk more about DNR orders later, but it's important to know they're a separate document from your living will.

Durable Power of Attorney for Healthcare (Healthcare Proxy)

A durable power of attorney for healthcare—also called a medical power of attorney or healthcare proxy—is the document where you choose someone to make medical decisions for you if you can't make them yourself.

This is arguably the most important decision in your entire advance care planning process. You're not just picking a name. You're choosing the person who will speak for you when you can't speak for yourself. This person needs to understand your values, be willing to honor your wishes even if they disagree, and be able to advocate for you in difficult medical situations.

Your healthcare proxy should be someone who knows you well, understands what matters to you, and can handle the emotional weight of making serious medical decisions under pressure. Often, people choose a spouse, adult child, sibling, or close friend. You should also name an alternate proxy in case your first choice isn't available in an emergency.

It's critical to have detailed conversations with your proxy before a crisis happens. They need to know your specific wishes, but they also need to understand your broader values and priorities. What does quality of life mean to you? Are there circumstances where you wouldn't want life-sustaining treatment? How important is pain management versus mental clarity? These conversations help your proxy make decisions that truly reflect what you would choose.

Typically, your healthcare proxy can't override the specific instructions in your living will—they're bound by what you've written. However, they do have authority to make decisions in situations you didn't specifically address. That's why choosing the right person and having honest conversations with them matters so much.

POLST/MOLST Forms (Physician Orders for Life-Sustaining Treatment)

POLST forms are different from living wills and advance directives. POLST stands for Physician Orders for Life-Sustaining Treatment (though some states use different names like MOLST or POST). Unlike advance directives, which are legal documents you create yourself, a POLST is a medical order form that you complete with your doctor.

POLST forms are specifically designed for people with serious illness or advanced frailty—those for whom a doctor would not be surprised if they died within the next year. If you're healthy, a POLST probably isn't appropriate for you right now. These forms address a narrow set of immediate, critical medical decisions: Do you want CPR? Do you want to be hospitalized or stay where you are? What level of medical intervention do you want?

The key difference is that POLST forms create actionable medical orders that emergency medical personnel must follow. If paramedics arrive at your home and you have a POLST form indicating you don't want CPR, they won't perform CPR. An advance directive alone wouldn't prevent that—it would only be consulted after you're in the hospital and doctors are reviewing your wishes.

POLST forms are printed on bright pink paper so they're easily recognizable by all healthcare personnel. They're designed to be portable—they travel with you from home to hospital to nursing home. And because they're medical orders signed by a physician, they carry immediate legal weight.

It's important to understand that POLST doesn't replace your advance directive. They work together. All adults should have advance directives. Only those with serious illness or advanced frailty should consider POLST. Your doctor can help you determine whether a POLST form is appropriate for your situation.

Do Not Resuscitate (DNR) Orders

A DNR order is a specific type of medical order that tells healthcare providers not to perform CPR if your heart stops beating or if you stop breathing. Without a DNR, the default assumption is that you want medical staff to attempt resuscitation, which typically includes chest compressions, electric shocks to the heart, and potentially inserting a breathing tube.

CPR can sometimes save lives. But it's also physically traumatic, especially for people who are elderly or already very sick. According to the American Heart Association, survival rates after in-hospital cardiac arrest are only about 25%, and significantly lower for out-of-hospital events. Even when successful, resuscitation can result in serious complications including broken ribs, brain damage from lack of oxygen, or a persistent vegetative state.

DNR orders are most common among people with terminal illnesses, advanced age, or serious chronic conditions where resuscitation is unlikely to be successful or would result in a quality of life the person doesn't want. Some people choose a DNR because they want to die naturally when the time comes. Others make this choice after understanding the realistic outcomes of CPR given their medical situation.

A DNR order can be part of a POLST form, or it can be a separate order in your medical records. If you want a DNR and you're at home or in a residential facility, you should have it documented on a POLST form so emergency medical personnel will honor it. If you're hospitalized, the DNR should be clearly noted in your hospital records.

One important clarification: a DNR doesn't mean "do not treat." You still receive all other medical care, including medication, surgery, dialysis, and any other interventions. It only applies to CPR and resuscitation efforts. Many people misunderstand this, thinking a DNR means giving up on all treatment. That's not the case at all.

Critical Healthcare Decisions to Consider

When you're filling out advance directives, you'll need to think through specific medical scenarios and what you'd want in each situation. These decisions are deeply personal. There's no right or wrong answer—only what's right for you based on your values, beliefs, and circumstances.

Life-Sustaining Treatments

Life-sustaining treatments are medical interventions that keep you alive when your body can't function on its own. You'll need to think about each of these and decide what you'd want under different circumstances:

Cardiopulmonary resuscitation (CPR) involves chest compressions and sometimes electric shocks to restart your heart if it stops beating. As we discussed earlier, CPR is more traumatic and less successful than most people realize, especially for older adults or people with serious illness.

Mechanical ventilation means having a machine breathe for you through a tube inserted in your throat. Some people recover and are able to breathe on their own again. Others remain dependent on the ventilator long-term or indefinitely.

Dialysis is a treatment that filters waste from your blood when your kidneys fail. It typically involves multiple sessions per week, each lasting several hours. For some people, it's a temporary measure while waiting for a kidney transplant. For others, it's a permanent treatment that continues for years.

Artificial nutrition and hydration means receiving food and water through a tube—either through your nose into your stomach, or through a surgical opening in your abdomen. This becomes necessary if you can't swallow safely. The question is whether you'd want this if you were permanently unable to eat or drink on your own.

Hospitalization versus staying home is a choice that matters when you're very ill. Some people prefer to be hospitalized to receive aggressive treatment. Others want to stay home with comfort care only, especially toward the end of life.

Antibiotics and medications for infections and other conditions. You might want all medications that could treat your condition, or you might choose only medications that provide comfort without trying to cure the underlying illness.

Blood transfusions to replace blood loss or treat certain conditions. Some people have religious or personal objections to receiving blood products and want to specify this in their advance directives.

For each of these, you can provide guidance about the circumstances that matter. You might want CPR if there's a reasonable chance of full recovery, but not if you're in the late stages of a terminal illness. You might want mechanical ventilation temporarily but not indefinitely. The specifics are up to you.

Pain Management and Comfort Care

Many people's biggest fear isn't death itself—it's suffering. Your advance directive can include instructions about pain management and comfort measures.

Palliative care focuses on relieving pain and other symptoms, improving quality of life, and providing support to patients and families. It's not the same as giving up on treatment—you can receive palliative care alongside curative treatment. But it's also an option on its own when curative treatment is no longer working or when you decide you don't want aggressive interventions.

Hospice care is a specific type of palliative care for people who are in the final months of life, typically when doctors believe they have six months or less to live. Hospice shifts the focus entirely to comfort rather than cure. It can be provided at home, in a hospice facility, or in a hospital or nursing home.

You can express your preferences about pain medication, even if it means you're less alert. Some people prioritize being awake and lucid as much as possible. Others prefer maximum pain relief, even if it makes them sleepy or confused. Your advance directive can reflect whichever matters more to you.

Organ and Tissue Donation

Your advance directive is also the place to document your wishes about organ and tissue donation. In the United States, about 100,000 people are currently on the waiting list for organ transplants, and 17 people die each day waiting for an organ.

You can choose to donate specific organs (heart, kidneys, liver, lungs, pancreas), donate tissues (corneas, skin, bone, heart valves), or donate your whole body for medical education and research. You can also choose not to donate at all.

If you want to be a donor, make sure this is documented clearly in your advance directive and that your healthcare proxy knows your wishes. You should also register as an organ donor with your state's donor registry—many states allow you to indicate this on your driver's license.

It's important to know that if you're a registered organ donor and you've documented this wish in your advance directive, doctors will still provide full medical treatment to try to save your life. Donation only happens after death has been declared using standard medical criteria. The healthcare team treating you is completely separate from the transplant team.

Other Important Considerations

Autopsy preferences: An autopsy is an examination after death to determine the cause. It's sometimes required by law in cases of unexpected death or suspected criminal activity. But in other cases, it's optional. You can express whether you're comfortable with an autopsy being performed if doctors think it would provide valuable medical information.

Pregnancy considerations: If you're a woman of childbearing age, you should think about how your wishes might be affected by pregnancy. Some states have laws that limit advance directives during pregnancy. You can specify how you want these situations handled.

Clinical trials and experimental treatments: Would you be open to trying experimental treatments if standard options aren't working? Some people want access to every possible option. Others prefer proven treatments only.

Religious and cultural considerations: Your faith, cultural background, and personal beliefs might affect the medical care you want to receive. Some religions have specific teachings about life-sustaining treatment, organ donation, or end-of-life care. Your advance directive can reflect these values and ensure your care aligns with your beliefs.

Having the Conversation with Your Loved Ones

Documents are essential, but they're not enough on their own. The conversations you have with your loved ones—especially your healthcare proxy—are just as important as the paperwork itself.

Why These Conversations Matter

When a medical crisis happens, there's no time for guessing. Your healthcare proxy needs to know not just what your wishes are, but why they matter to you. They need to understand your values deeply enough to make decisions you didn't specifically address in your advance directive.

These conversations also help prevent family conflict. When you clearly communicate your wishes to everyone who matters, you reduce the chances of disagreements during a crisis. Family members might still struggle emotionally with your decisions, but at least they'll know those decisions came from you, not from someone else's interpretation.

And honestly, these conversations often bring people closer. Talking openly about mortality, values, and what matters most in life can strengthen relationships. It's vulnerable and real in a way that everyday conversation often isn't.

How to Start the Discussion

Choose a calm, quiet time when you won't be interrupted. Don't bring up advance care planning during a family crisis or when someone is actively sick. Frame the conversation as something you're doing to protect them, not because you expect something bad to happen soon.

You might start with something like: "I've been thinking about advance care planning, and I want to make sure you know my wishes if something unexpected happens. Can we talk about this?" Or: "I'm working on my advance directive, and I'd really value your input. Would you be willing to talk through some of these decisions with me?"

Here are some questions that can guide the conversation:

What does a good quality of life mean to you? What would make life not worth living? Would you want to live if you were permanently unconscious? If you were in severe, unrelenting pain? If you couldn't recognize your family?

Are there medical situations where you absolutely would or wouldn't want life-sustaining treatment? Are there religious or cultural beliefs that affect your medical preferences?

Who do you trust to make healthcare decisions for you? Have you talked to them about being your healthcare proxy? What do they need to know?

Where would you want to be if you were seriously ill or dying? In a hospital? At home? What kind of environment matters to you?

What fears do you have about end-of-life care? What gives you hope or comfort when you think about the future?

These aren't easy questions. It's okay if the conversation takes multiple sessions. It's okay to feel emotional. The goal isn't to have all the answers right away—it's to start the dialogue and keep it going.

Navigating Difficult Family Dynamics

Sometimes family members disagree with your choices. Maybe they can't imagine letting you go without every possible medical intervention. Maybe they think you're being too negative or giving up too soon. Maybe their religious beliefs differ from yours.

Here's the truth: these are your decisions about your body and your medical care. You don't need permission or approval. What you do need is to communicate your wishes clearly and firmly.

If family members push back, you can acknowledge their feelings while standing firm: "I understand this is hard for you. I know you want me to have every possible treatment. But I need you to understand that this is what I want. I need to know that you'll respect my wishes, even if you disagree with them."

Sometimes it helps to involve a neutral third party—a doctor, a counselor, a religious leader, or a patient advocate. They can help facilitate the conversation, answer questions, and provide perspective.

If you know your family will struggle with your choices, document everything clearly in writing. Make sure your advance directive is specific and unambiguous. Have conversations with your healthcare proxy without other family members present, so you can speak freely about your concerns.

And consider providing context in your advance directive. Many forms include space for you to explain your reasoning. A statement like "I've seen my mother suffer through months of aggressive treatment that didn't improve her quality of life, and I don't want that for myself" can help family members understand where you're coming from.

Following Up on Conversations

Advance care planning isn't a one-time discussion. Your wishes might change as you age, as your health changes, or as you simply reflect more on what matters to you. Make it a habit to revisit these conversations periodically.

After major life events—a serious diagnosis, a hospitalization, the death of a loved one—check in with your healthcare proxy. Ask: "Are you still comfortable being my proxy? Do you have any questions about what I'd want?"

When you update your documents (which we'll discuss more later), let your proxy and family members know. Give them updated copies. Make sure they know where to find your advance directive if they need it quickly.

Completing Your Advance Care Planning Documents

Once you've thought through your wishes and had conversations with your loved ones, it's time to put everything in writing. Here's how to actually complete your advance care planning documents.

Getting Started

Before you start filling out forms, spend time reflecting on your values. What matters most to you? Independence? Being present for family? Avoiding suffering? Understanding your core values will guide all your specific decisions.

Think about experiences you've had with serious illness—either your own or someone else's. What did you observe? What do you want for yourself? What do you absolutely want to avoid?

Talk to your doctor about your current health status and any concerns you have about future care. They can help you understand which scenarios are most relevant to think about given your medical history.

Consider using decision-making tools and worksheets. The National Institute on Aging offers free advance care planning worksheets. PREPARE is an interactive online program that walks you through the decision-making process with videos and examples.

State-Specific Requirements

Here's something important: advance directive laws vary by state. Each state has its own requirements for what makes an advance directive legally valid. Most states honor advance directives created in other states, but there's no guarantee.

If you live in one state and work in another, or if you spend significant time in multiple states, consider completing advance directives for each state. The National Hospice and Palliative Care Organization provides free state-specific advance directive forms for all 50 states.

Most states require that your advance directive be either witnessed by two adults or notarized (some allow either option, while others require both). Witnesses typically can't be your healthcare proxy, family members who would inherit from you, or anyone involved in your medical care. Check your state's specific requirements.

If you're in the military or a veteran receiving care through the VA, there are special considerations. The VA honors state advance directives, but they also have their own forms you can use. Talk to your VA provider about what documents you need.

Filling Out the Forms

When you're ready to complete your advance directive, set aside dedicated time when you can focus without distractions. Don't rush through it.

Read all instructions carefully before you start. Make sure you understand what each section is asking. If something is confusing, get help rather than guessing—from your doctor, a lawyer, or a patient advocate.

Be as specific as you can without being so detailed that your directive becomes unworkable. For example, instead of writing "I don't want to be kept alive artificially," you might write "I don't want mechanical ventilation, feeding tubes, or dialysis if I'm in a persistent vegetative state with no chance of recovery."

But also recognize that you can't anticipate every possible scenario. It's okay to provide general guidance for situations you haven't specifically addressed. That's one reason having a healthcare proxy you trust is so important—they'll handle the details you couldn't predict.

Use clear, straightforward language. Avoid medical jargon unless you're sure everyone will understand it. Remember that emergency medical personnel might be reading this document in a crisis situation. It needs to be immediately clear what you want.

If you have strong feelings about specific treatments, say so directly: "Under no circumstances do I want to receive CPR if I'm in the late stages of terminal cancer." Or: "I want aggressive treatment including life support if there's any chance of meaningful recovery."

Don't leave questions blank unless the form specifically says it's optional. Blank sections can create confusion about whether you forgot to answer or intentionally chose not to address something.

Getting Proper Signatures and Witnesses

Once you've completed your advance directive, you need to make it legally valid by getting the required signatures and witnesses or notarization.

If your state requires witnesses, choose people who meet your state's requirements. They need to see you sign the document and verify that you're doing so willingly and that you appear to be of sound mind. Your witnesses then sign the document themselves.

If your state requires or allows notarization, bring your completed but unsigned document to a notary public (available at many banks, UPS stores, and government offices). You'll sign the document in front of the notary, who will verify your identity and witness your signature.

Your healthcare proxy needs to receive a copy of the document and sign an acceptance form (if required by your state). Some states don't require the proxy to sign anything, but it's still a good idea to give them a copy and confirm they understand and accept the responsibility.

Once everything is signed, make copies before you give the original away. You'll want to keep the original in a safe but accessible place, and distribute copies to everyone who needs them.

Storing and Sharing Your Documents

Your advance directive only works if people can find it when they need it. A beautifully completed form sitting in a safe deposit box doesn't help anyone in an emergency.

Where to Keep Original Documents

Keep the original in a place that's both safe and accessible. That sounds contradictory, but here's what it means: safe from damage or loss, but accessible to trusted people in an emergency.

A fireproof and waterproof box in your home is a good option. Some people keep important documents in a specific drawer or folder that family members know about. Just make sure it's somewhere obvious enough that your healthcare proxy can find it quickly, even in the middle of the night.

A safe deposit box at a bank is not a good place for your advance directive. Banks have limited hours, and the box might not be accessible when you need it.

Digital Storage Options

Many people also store digital copies of their advance directives. This provides backup and makes it easy to share copies with new doctors or facilities.

There are online advance directive registries where you can upload your documents securely. Services like MyDirectives provide free, secure storage and make your documents available 24/7 to you and your medical providers anywhere in the world.

You can also store copies in secure cloud storage like Google Drive or Dropbox, though make sure someone knows how to access your account in an emergency. Some people include advance directive information in medical ID apps on their phones.

A word of caution: digital storage should supplement physical copies, not replace them. In an emergency, medical personnel need to see the actual document quickly. They're not going to wait for someone to log into your cloud account.

Who Should Have Copies

Your healthcare proxy should have a copy of your advance directive. So should your alternate proxy. They need to be able to access it immediately if something happens to you.

Your primary care doctor should have a copy in your medical records. If you have specialists you see regularly, give them copies too. Any time you're admitted to a hospital or enter a residential facility, provide them with a copy for your file.

Close family members should know you have advance directives and where to find them, even if they don't each have their own copy. You don't want to create a situation where multiple people have different versions of the document, so be careful about distributing too many copies.

If you work with a lawyer who helped you create your advance directive, they typically keep a copy in your file.

Making Sure Documents Are Found

Consider carrying a wallet card that states you have an advance directive and where it's located. Many advance directive programs provide these cards automatically.

Some people wear medical alert bracelets that indicate they have advance directives or specific wishes like a DNR order. This can be especially important if you have serious health conditions or are at high risk for emergencies.

Create an emergency information binder—a physical folder or notebook that contains all your important documents and information in one place. Include your advance directive, insurance information, medication list, emergency contacts, and instructions about where other important documents are located.

Tell people where your documents are. It sounds obvious, but many families discover advance directives only after someone has already been in the hospital for days. Have explicit conversations: "If something happens to me, my advance directive is in the blue folder in the second drawer of my desk."

Reviewing and Updating Your Plan

Advance directives aren't set in stone. They should change as you change. Regular review and updates ensure your documents continue to reflect your actual wishes.

When to Review Your Documents

Healthcare experts often recommend reviewing your advance directive whenever one of the "5 Ds" happens:

Decade. Every 10 years, or whenever you reach a significant birthday milestone. Your perspective on aging and healthcare likely changes as you move through different life stages.

Diagnosis. Any new serious diagnosis—cancer, heart disease, Alzheimer's, or other life-limiting conditions. Your priorities might shift when you're facing serious illness.

Decline. If your health worsens or your functional status changes significantly. Maybe you can no longer live independently, or you've had a major health event like a stroke or heart attack.

Divorce or relationship change. If you've named your spouse or partner as your healthcare proxy and that relationship ends, you need to update your documents immediately.

Death. If your healthcare proxy dies, you need to designate a new one. Same if someone you named as an alternate proxy or someone who witnessed your original documents passes away.

Beyond the 5 Ds, review your advance directive after any major life change: marriage, the birth of children or grandchildren, moving to a new state, retirement, or any shift in your values or religious beliefs.

Even without major changes, it's a good idea to review your advance directive every few years just to make sure it still reflects what you want.

How to Make Updates

To update your advance directive, you typically need to create a new document rather than just crossing out and writing in changes. This prevents confusion about what's current and what's been superseded.

Follow the same process you used to create the original: fill out a new form, get the required witnesses or notarization, and make copies to distribute.

When you create a new advance directive, you must void the old one. Draw a line through it, write "VOID" clearly across the pages, and include the date you're voiding it. Make sure everyone who has a copy of the old version gets the new one.

Tell everyone who needs to know that you've updated your documents. Don't assume they'll figure it out on their own. Call your healthcare proxy, email your doctor's office, and notify family members who should be aware.

Keep a record of version dates. You might write at the top of your advance directive: "This directive dated [date] supersedes all previous versions." That makes it crystal clear which document is current.

Common Myths and Misconceptions About Advance Care Planning

A lot of confusion and fear surrounds advance care planning. Let's address some of the most common myths that prevent people from completing this important process.

"I'm too young to need this." Serious illness and accidents don't check your age before they happen. Anyone over 18 should have an advance directive. In fact, younger adults are sometimes more vulnerable because they don't have these documents in place and their families have to scramble during a crisis.

"My family will know what I want." Maybe they will, maybe they won't. But why put them in the position of having to guess during an already terrible time? Even close family members often disagree about what their loved one would have wanted. Clear documentation prevents that conflict.

"Advance directives mean giving up on treatment." Not at all. Your advance directive can say "I want every possible treatment" just as easily as it can say "I don't want life support." It's about documenting your wishes, whatever they are.

"Once I sign, I can't change my mind." You can update your advance directive any time. In fact, you should update it whenever your wishes change or your circumstances shift significantly.

"These documents are expensive to create." Many states offer free advance directive forms. You don't necessarily need a lawyer to complete them, though some people prefer to work with an attorney for complex situations. Even if you do hire a lawyer, advance directives are typically one of the less expensive legal documents you can create.

"DNR means 'do not treat.'" A DNR order only applies to cardiopulmonary resuscitation—restarting your heart if it stops. It doesn't affect any other medical treatment. You still receive medications, surgery, dialysis, and everything else. This is one of the most dangerous misconceptions because it prevents people from creating DNR orders that would actually align with their wishes.

"My healthcare proxy can make any decision they want." Your proxy is bound by your advance directive. They're supposed to make decisions based on what you would want, not what they want for you. If you've clearly documented your wishes, your proxy should honor them.

"POLST is required for everyone." POLST forms are only appropriate for people with serious illness or advanced frailty. Healthy people don't need POLST—they need advance directives.

Special Considerations in Advance Care Planning

Some situations require additional thought and planning beyond the standard advance care planning process.

Cultural and Religious Factors

Your cultural background and religious beliefs profoundly affect how you think about illness, death, and medical care. Advance care planning should reflect these values, not override them.

Many religions have specific teachings about end-of-life care. Some faiths emphasize preserving life at all costs. Others focus on natural death without artificial intervention. Some have specific practices around the body after death. If your faith is important to you, talk to religious leaders in your community about how your beliefs should inform your advance care planning.

Cultural attitudes toward discussing death vary widely too. Some cultures are comfortable with direct conversation about mortality. Others consider it disrespectful or bad luck to talk about death while someone is still healthy. If you're navigating cultural expectations that make advance care planning difficult, consider working with a healthcare advocate who understands your cultural context and can help you find a path forward that honors both your culture and your need for planning.

You can explicitly address religious and cultural preferences in your advance directive. For example, you might write: "I request that all medical decisions be made consistent with the teachings of [your faith]" or "I want [specific cultural practices] honored after my death."

Cognitive Decline and Dementia

If you or someone you love is experiencing cognitive changes or has been diagnosed with dementia, advance care planning becomes especially urgent—and especially challenging.

The best time to complete advance directives is early in the disease process, while the person still has the capacity to make and communicate their own decisions. Once dementia progresses to a certain point, the person may no longer have the legal capacity to create advance directives.

With dementia, it's important to think through scenarios specific to cognitive decline. Would you want a feeding tube if you couldn't eat on your own? Would you want treatment for infections like pneumonia if you no longer recognized your family? How aggressive should treatment be at different stages of the disease?

The progressive nature of dementia also means reviewing and updating advance directives regularly is crucial. Someone in the early stages of Alzheimer's might still want aggressive treatment for other health problems. Later in the disease, their priorities might shift toward comfort care only.

If you're creating advance directives for someone with dementia, make sure they still have the capacity to understand what they're signing. A doctor can assess decision-making capacity if there's any question. It's also especially important to involve the healthcare proxy in detailed conversations now, while the person can still explain their reasoning.

Terminal Illness

Being diagnosed with a terminal illness changes everything about advance care planning. Suddenly, these aren't theoretical questions about distant future scenarios—they're immediate, practical decisions about your care right now.

If you have a terminal diagnosis, work with your medical team to understand your prognosis and treatment options realistically. What are the possible outcomes with treatment? Without treatment? What will your quality of life look like? How much time might you have?

This is when conversations about palliative care and hospice become especially important. Many people with terminal illness benefit from these services but wait too long to access them. Earlier integration of palliative care often means better quality of life during the time you have left.

Your advance directive should address your goals given your prognosis. Are you focused on extending life as long as possible? On maintaining quality of life and comfort? On having time at home with family? There's no wrong answer—only what's right for you.

Consider completing a POLST form in addition to your advance directive. As we discussed earlier, POLST creates immediate medical orders that can be especially important when you have a serious, life-limiting condition.

Pregnancy and Reproductive Health

If you're a woman of childbearing age, you should know that some states have laws limiting advance directives during pregnancy. These laws vary widely—some states automatically suspend advance directives if you're pregnant, while others give you more control over your wishes even if you're pregnant.

You can address pregnancy in your advance directive by stating your preferences explicitly. For example: "If I am pregnant, my decision-making authority should not be limited, and my healthcare proxy should make decisions based on my wishes as stated here" or "If I am pregnant, I want every effort made to preserve the pregnancy."

High-risk pregnancies, pregnancy later in life, or pregnancy with chronic health conditions all increase the importance of having clear advance directives that address what you'd want if complications arose.

Advance Care Planning and Healthcare Costs

Medicare covers advance care planning conversations with your doctor. As of 2016, Medicare pays for time your doctor spends discussing advance directives with you, either as part of your annual wellness visit or as a separate service.

This means you can schedule an appointment with your doctor specifically to discuss advance care planning, and Medicare will cover it. Your doctor can bill for the first 30 minutes of discussion and for each additional 30 minutes after that.

Most private insurance plans also cover advance care planning discussions, though specifics vary by plan. Check with your insurance company about coverage.

The documents themselves are typically free or very low cost. Every state has standard advance directive forms you can download and complete yourself at no charge. If you want legal help, hiring an attorney to review or draft advance directives usually costs a few hundred dollars at most—significantly less than other legal documents like wills or trusts.

Some people complete advance directives as part of broader estate planning, which can be more expensive but covers all your end-of-life planning needs in one comprehensive process.

Compare this to the potential costs of not having advance directives: Family members making decisions without guidance. Unwanted medical interventions that are expensive and traumatic. Extended hospital stays. Legal disputes among family members. Financial costs aside, the emotional toll of navigating healthcare decisions without direction is enormous.

How a Solace Advocate Can Help

Advance care planning touches on some of the most difficult decisions you'll ever make. It involves complex medical terminology, confusing legal documents, emotional family conversations, and questions about mortality that many people would rather avoid. The system doesn't make it easy—and that's exactly why a Solace advocate can make all the difference.

Your Solace advocate isn't a stranger in a call center reading from a script. You work with one dedicated person who gets to know you, understands your values, and stays with you through the entire advance care planning process—and beyond.

Here's exactly how we help:

We help you clarify your values and wishes. Before you can fill out forms, you need to understand what matters most to you. Your advocate sits down with you (virtually or in person) to talk through different scenarios, explain medical terms, and help you think through what you actually want. We ask the questions that help you reflect on your priorities, and we make sure you understand the real implications of different choices.

We explain complex medical and legal concepts in plain language. Healthcare proxies versus living wills versus POLST forms—the terminology is confusing on purpose. We translate all of it into clear, straightforward language so you can make informed decisions. If your doctor uses medical jargon you don't understand, we explain what it means for your specific situation.

We help you complete all the necessary documents correctly. State-specific requirements, witness rules, notarization, proper signatures—the paperwork alone is enough to make people give up. Your advocate walks you through every form, makes sure you've addressed all the important questions, and ensures everything is completed correctly the first time. We know which documents you need for your state and situation.

We facilitate difficult family conversations. Talking to your spouse, adult children, or siblings about your end-of-life wishes can be emotionally charged and complicated. Your advocate can join these conversations to help keep them productive, answer questions from family members, and help everyone understand your reasoning. Sometimes having a neutral third party present makes these discussions easier.

We coordinate with your healthcare team. Once your documents are complete, we make sure copies get to all the right places: your doctors, your hospital, your specialists. If you're admitted to a facility, we ensure they have your advance directive in your records. If you update your documents, we handle getting new copies to everyone who needs them.

We keep everything organized and accessible. Your advocate maintains a record of all your advance care planning documents, tracks version dates, and reminds you when it's time to review and potentially update them. We make sure you—and your healthcare proxy—always know where to find the current versions.

We're there when circumstances change. Got a new diagnosis? Health declining? Need to update your healthcare proxy? Moving to a different state? Your advocate helps you reassess your advance directives and make any necessary changes. We understand that advance care planning isn't a one-time task—it's an ongoing process that should evolve with you.

We advocate for your wishes to be honored. If you're hospitalized and there's any confusion about your advance directive, your advocate steps in. We communicate with your medical team, clarify your documented wishes, and make sure they're being followed. We serve as a bridge between what you decided when you were healthy and what happens when you're too sick to speak for yourself.

This is what Solace advocates do. We don't just help you fill out paperwork. We walk alongside you through one of life's most challenging planning processes, ensuring your voice is heard when it matters most.

Frequently Asked Questions

What's the difference between a living will and a healthcare proxy?

A living will documents your specific treatment preferences—what medical care you want or don't want under different circumstances. A healthcare proxy (also called a durable power of attorney for healthcare) is a person you choose to make healthcare decisions for you when you can't make them yourself. You need both: the living will provides specific instructions, and the proxy makes decisions in situations you didn't specifically address. Think of the living will as your detailed wishes, and the proxy as the person who implements them.

Do I need both an advance directive and a POLST form?

All adults should have an advance directive (living will and healthcare proxy). POLST forms are only appropriate for people with serious illness or advanced frailty—typically those for whom their doctor would not be surprised if they died within the year. If you're healthy, stick with advance directives. If you're seriously ill, consider adding a POLST form to work alongside your advance directive, not replace it. Your doctor can help you determine if POLST is appropriate for your situation.

Can my healthcare proxy override my living will?

Generally, no. Your healthcare proxy is bound by the specific instructions in your living will. However, they do have authority to make decisions about situations you didn't address in your living will—and there will always be scenarios you couldn't predict. This is why choosing a proxy who truly understands your values and will honor your wishes is so important. Some states allow you to give your proxy broader authority to override your living will if they believe circumstances have changed, but only if you explicitly grant that power in the document.

What happens if I don't have advance directives?

If you become incapacitated without advance directives, someone will still make healthcare decisions for you—but it might not be the person you would have chosen. Most states have laws about who has legal authority to make medical decisions (typically a spouse, then adult children, then parents, then siblings). These family members will have to guess what you would want, and they might not all agree, leading to conflict at an already painful time. Medical teams will also default to standard protocols, which often means aggressive treatment even if that's not what you would have wanted. Without documented wishes, there's no clear way to honor your preferences.

How do I change my healthcare proxy?

To change your healthcare proxy, you need to complete a new advance directive naming the new person and following your state's requirements for witnesses or notarization. Make sure you void your old advance directive by writing "VOID" across it and dating when you voided it. Then give copies of the new document to your new proxy, your doctors, and anyone who had copies of the old version. You should also tell your previous proxy directly that you've made a change—it's respectful and prevents confusion if an emergency happens. If your new proxy hasn't formally accepted the role, have that conversation and make sure they understand and agree to the responsibility.

Are advance directives honored in all states?

Most states honor advance directives created in other states, but it's not guaranteed. Each state has its own laws about what makes an advance directive valid. If you live in one state but spend significant time in another (like snowbirds who live in different states seasonally), or if you move to a new state, it's a good idea to create an advance directive that meets the new state's requirements. Your healthcare proxy appointment usually remains valid across state lines, but the specific treatment instructions in your living will might need to be updated to comply with different state laws. When in doubt, complete a new advance directive using your current state's forms.

What if my family disagrees with my advance directive?

Your advance directive is a legal document that represents your autonomous medical decisions. Family members don't get to override it just because they disagree. However, emotionally charged situations can still create conflict. This is why it's so important to have clear, detailed conversations with your family while you're healthy—so they understand not just what you want, but why. Document your reasoning in your advance directive if you anticipate disagreement. Choose a healthcare proxy who you trust will advocate for your wishes even if other family members push back. If serious conflict arises when your advance directive is being implemented, your healthcare team and hospital ethics committees can help mediate, and ultimately, your documented wishes should prevail.

Do advance directives expire?

Advance directives don't automatically expire unless you specifically included an expiration date (which is rare and not recommended). However, they should be reviewed and updated regularly—especially after major life events, changes in health status, or shifts in your values and preferences. Some states recommend reviewing advance directives every 5-10 years even if nothing has changed. If your advance directive is very old, healthcare providers might question whether it still reflects your current wishes, so periodic updates help ensure your documents are taken seriously when needed.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

Related Reading

• End-of-Life Planning Support: How Solace Advocates Help Families Prepare
• What Is a Health Advocate and How Can They Help You?
• What to Do After a Dementia Diagnosis: Steps to Take and Support Options
• What Is Hospice Care at Home?
• Everything You Need to Know About Hospital Discharge (Updated May 2025)

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