Preparing a living will and end-of-life care choices

Having a will or trust is a key aspect of estate planning, but do you have a living will or other advance health care directives? According to a 2023 study by Stat Pearls, only 26% of Americans currently have an advance directive in place.

An advance health care directive lists an individual’s health care preferences so that physicians, family and friends know what should be done when they experience a medical issue that renders them unable to communicate or make decisions. While advance care planning can be expressed verbally, it’s more common that the patient’s wishes are written into official legal documents to avoid miscommunication.

While your end-of-life care may not be the first and foremost item on your mind, making the tough decisions about life-sustaining medical treatments when you're healthy — and documenting them in an advance health directive — helps to confirm that your health care wishes are fulfilled when you're unable to speak for yourself. When you make choices, it may also provide your loved ones with assurance that your wishes will be followed.

Some types of advance directives

What is a living will?

A living will is a type of advance directive that outlines your health care wishes if you become terminally ill and/or permanently incapacitated or unconscious due to injury, illness or old age. It can be important to have a living will because it communicates your wishes and gives your loved ones guidance in making difficult decisions.

A living will helps health care providers and your family know which life-sustaining medical treatments you want or don't want. Possible medical decisions include CPR, tube feeding, dialysis, mechanical ventilation, antibiotics or antiviral medications, comfort care, organ or tissue donations and body donations for scientific study. Each state defines the parameters differently, so check your state law to know what applies to you. Since a living will can't anticipate every possible situation, consider combining your living will with a health care power of attorney.

What is a health care power of attorney?

A health care power of attorney, or medical power of attorney, is a legal document that grants power to another person to make health care decisions on your behalf should you become so ill or injured that you can't do it for yourself. This person is called a health care agent, or health care proxy. Confirm that your health care agent is someone you trust to advocate for you, to be available for what could be a significant amount of time and to remain steady during a highly emotional time.

What are Physician Orders for Life-Sustaining Treatment (POLST)?

A POLST form is technically not categorized as an advance directive but serves similar functions in an emergency scenario. The difference is that EMTs and paramedics are not able to use an advance directive to determine treatment. They can, however, use POLST forms, as they apply to all health care professionals. POLST forms list preferences such as whether to take the patient to the hospital or perform CPR when incapacitated, but are only available in some states. If a doctor-signed POLST form isn’t in place in the event of a health emergency, on-site personnel are required to do everything in their power to keep you alive.

What are do-not-resuscitate (DNR) orders?

Resuscitation refers to the act of restarting your heart or breathing using methods like CPR or a defibrillator. A do-not-resuscitate order allows you to choose whether you want these treatments in an emergency. Notably, this directive doesn’t include instruction for other treatments such as pain medicine or nutrition and applies only to methods that involve a restart of your heart or breathing functions. Before pursuing this option, consider thinking carefully and communicate with family members who may be affected.

How to create a living will or advance directive

Hire an attorney or do it yourself

An attorney who focuses on developing an estate plan can produce an advance directive for you and will know your state's laws. If instead, you’d like to figure out how to create an advance directive without a lawyer, know that it must meet your state's requirements to be considered legitimate. Resources available include legal document creation software; a free living will form provided by your physician, local hospital, local senior center or state's medical association and The National Hospice and Palliative Care Organization, which allows you to download a state-specific advance directive form.

Research your state’s requirements

No matter how you create your advance directive, find out your state's requirements. You must be at least 18 years old and of sound mind when you create your living will. Depending on your state, you may also need witnesses and/or notarization.

Determine your end-of-life care

Decide what kind of medical treatments you want for yourself, such as artificial respiration, palliative care or nourishment, when you get to the end of life or become completely incapacitated. Consider researching these health care matters and discuss them with your physician. Once you've made your decisions, write them down along with your rationale and feelings to help your loved ones understand your preferences, especially if it's possible they might disagree. The type of advance directive you’ll need will depend on the preferences you’re looking to have included. Your physician or health care agent can help advise.

Reassess your living will as needed

Your advance directive isn't set in stone. Change it as your perspective or situation changes due to age, health decline or a major life event, such as a death, divorce or diagnosis.

Share your health care wishes

Tell your health care agent and family

Let your health care proxy and loved ones know of your advance directive and your life-prolonging preferences. This way, your health care agent may know how to act on your behalf and your family will be informed should something happen.

Keep your advance directive in a safe place

See that your living will and health care power of attorney are kept in a safe place that your health care agent can access, if needed.

Make copies of your advance directive

In addition to your health care agent and family, give a copy of your advance directive to your physician to keep on file, as well as to your hospital, if you are going in for a major procedure.

While creating an advance directive can be difficult in the short term, it may provide the potential benefit of helping ensure that your wishes are considered and possibly relieving your loved ones from the burden of making difficult decisions on your behalf during an emotionally stressful time.