Advance directives are documents that let you make decisions regarding your future medical care based on your preferences and values. Living wills and healthcare proxies (also known as a durable medical power of attorney) are the two most common types of advance directives that you'll encounter, and some states may let you combine them into the same document.
An integral part of both advance planning and estate planning, advance directives help people prepare for what happens as they get older or become incapacitated, and as such people of any age can benefit from creating these documents.
1. Living will
This advance directive lets you articulate your preferences for end-of-life medical care and life-sustaining treatment, like whether you want to be kept to a machine that keeps you breathing. You can also make decisions regarding palliative care, tube feeding (artificial nutrition), blood transfusions, and CPR.
Without a living will, your family faces the burden of trying to determine your wishes for you. You can save them the trouble by creating this advance directive document that thoroughly outlines your desires. Keep in mind that a living will is different from a last will and testament, which provides instructions on who should receive your assets.
Learn more about what you can do with a living will.
2. Healthcare proxy (durable medical power of attorney)
You can appoint someone you trust to make healthcare decisions on your behalf if you're terminally ill or mentally incapacitated with a durable medical power of attorney. The POA document grants the person legal authority as your proxy, agent, or attorney-in-fact. Your healthcare agent should try to follow instructions left in your living will, and they can step in to make decisions that aren't outlined in it as well.
Learn more about medical power of attorney and how to get one.
3. Do not resuscitate order (DNR)
A DNR is a medical order that must be completed by a healthcare provider. It is also known as a DNAR (do not attempt resuscitation) or an AND (allow natural death) order.
In emergency situations, medical professionals are legally required to try and resuscitate you, or jumpstart your heart or breathing with CPR and/or defibrillator. If you do not want to be resuscitated, you can obtain a do not resuscitate order or include it in your living will.
States have different laws regarding when DNRs are applicable and how to get one; forms are commonly issued by state health departments and require signoff from your doctor. If you are staying at a hospital, you may have to file a DNR with them during each visit so your preferences are known to the attending physician and other healthcare providers. You may also be able to get a nonhospital DNR order, like a bracelet or wallet card, which can more easily let emergency medical teams know that you do not want to be resuscitated.
4. Physician’s order for life sustaining treatment (POLST)
POLSTs are also medical orders completed by a doctor, and they are portable so they should be honored by other physicians and medical professionals that you come in contact with.
Because it is focused on your current health status and the emergency care you would need, a physician’s order is reviewed periodically by the doctor. They are best suited for elderly people who are critically ill or may pass away soon, who can use POLST form to indicate what type of care they should receive as they move through different healthcare facilities like hospitals, rehabs, and nursing homes.
In order to get a POLST, you typically need to go through a process where you discuss your treatment plans thoroughly with your doctor before they can sign off and create the order. Most states have a portable order program in place, and it may go by different names — like physician's orders for scope of treatment (POST); medical orders for life sustaining treatment (MOLST); and medical orders for scope of treatment (MOST). Also, depending on your state, you can use a POLST in addition to or in lieu of the DNR.
Where to get advance directives
In most states, anyone above the age of the majority can create a living will and power of attorney through any of the following methods
Find a template online or use an online service
Hire an attorney who specializes in elder law or estate planning
Check your local hospitals that hold classes or information sessions to help you create one
Legal documents tend to be state-specific, so if you split your time in different places you should make an advance directive for each state.
Learn more about other estate planning documents.
