Living Wills and Advance Directives for Medical Decisions

Choosing Someone to Make Healthcare Choices for You

A healthcare power of attorney lets a person name someone to act on their behalf if they become unable to decide about their care. This trusted person may be called a healthcare agent, healthcare proxy, healthcare surrogate, healthcare representative, attorney-in-fact, or patient advocate. The person chosen has the legal right to make healthcare choices when the individual cannot.

It is important to pick someone who understands your wishes, can handle stress, and is willing to speak up for what you want. They should not be your healthcare provider or part of your care team. You might give this role to a spouse, family member, close friend, or someone from your place of worship. It’s also wise to select backup agents, in case your main agent cannot help.

Key Qualities for an Effective Healthcare Representative

Quality	Why It Matters
Understands your values.	They can follow your wishes and make hard choices.
Can communicate well.	Able to talk to doctors, staff, and family.
Is decisive in stressful times.	Will act quickly and calmly if urgent care is needed.
Will stand firm during disagreements.	Can help prevent confusion or disputes among others.
Meets legal requirements.	Some states have rules on who can be an agent.

The healthcare agent may need to decide about different types of care, life support, and end-of-life options. They should feel comfortable talking about tough subjects and be willing to honor your wishes, even if others disagree.

Explaining a Written Statement of Medical Wishes

A living will is a legal document where a person records which treatments they want or do not want if they cannot speak for themselves. This may include starting or stopping certain therapies, as well as choices about pain relief and organ donation.

People should think about their own beliefs and what quality of life means to them. Some may want to stay alive by any means, while others may wish to refuse treatment if recovery is not expected. In a living will, a person may write their wishes regarding:

Cardiopulmonary Resuscitation (CPR): Whether they want attempts to restart the heart if it stops.
Mechanical Ventilation: If and for how long they would be connected to a machine to help them breathe.
Feeding Tubes: If they accept fluids and nutrition through artificial tubes if they cannot eat or drink.
Dialysis: Whether their blood should be filtered by a machine if their kidneys fail.
Antibiotics: If infections should be treated with medication at the end of life.
Comfort (Palliative) Care: Requests to focus on pain control and comfort, rather than curing illness.
Organ and Tissue Donation: Whether they want to donate organs and tissues for transplants.
Body Donation: Giving their body for research or medical study.

Example Table: Key Items to Address in a Living Will

Medical Decision	Possible Choice
CPR	Yes / No
Mechanical Ventilation	Yes / No / Only for limited time
Tube Feeding	Yes / No / Only if recovery is likely
Dialysis	Yes / No / Only short-term
Antibiotics	Yes / No / Only if meaningful recovery is possible
Comfort Care	As much as needed
Organ/Tissue Donation	Yes / No
Body Donation	Yes / No

A living will helps doctors, family members, and agents understand what treatments the person wants or does not want. It can prevent confusion and disagreements during a crisis.

Requests for No Resuscitation or No Breathing Tube

Do not resuscitate (DNR) and do not intubate (DNI) orders are instructions not to perform CPR or place a breathing tube if the heart or breathing stops. While people may state these wishes in a living will, DNR or DNI orders are separate instructions that a doctor must write and add to a person’s health record.

A person or their legal representative must talk to a doctor about DNR or DNI wishes. Once a doctor writes the order, it becomes part of the medical record and should be shared with other doctors or hospitals if the person changes locations. Sometimes, people keep copies at home or in a folder to show emergency workers if needed.

DNR: Tells medical staff not to attempt to restart the heart or breathing using CPR/manual methods.
DNI: Tells medical staff not to use a breathing tube or machine if breathing stops.

Even if someone has these wishes in a living will, they should create a DNR or DNI order at each new hospital or care facility, because these instructions often do not travel between healthcare systems.

Steps to Creating Health Care Instructions

People must write down advance directives, including living wills and power of attorney documents, for them to be valid. Each state has its own laws and forms for writing and signing these papers. Some states may require one or more witnesses, while others ask for a notary to watch the signing.

Most people can prepare their own forms without a lawyer, but legal advice may help if wishes are complex. Reliable forms are available from trusted groups like the National Hospice and Palliative Care Organization. Important steps to finalize advance directives:

Fill out the correct state forms according to the latest rules.
Have all required signatures, witnesses, or notary as needed.
Talk over choices with a doctor and the selected healthcare agent to ensure details are clear.
Make copies and share them:
- Keep the original document in a safe, easy-to-find place.
- Give a copy to the primary doctor and discuss any DNR or DNI directions.
- Give copies to your agent and any backup agents.
- Record who has received a copy.
Discuss choices with family members, making sure everyone understands the person’s wishes to reduce confusion and possible disagreements later.

Tips for Talking to Family about Health Care Wishes

Be clear and direct about preferred treatments.
Encourage questions from loved ones.
Address religious beliefs or cultural values.
Discuss how healthcare choices fit with organ or tissue donation wishes.
Remind family that these choices are made to prevent stress and uncertainty in tough times.

How to Update or Cancel Health Care Directions

People’s feelings and desires about health care can change over time, so reviewing advance directives regularly is smart, especially after important life changes or health events. Times when review is wise include:

Major change in health, such as a new diagnosis or terminal illness.
Marriage, divorce, or the death of a person’s agent.
Start or end of significant treatments, like dialysis or tube feeding.
Moving to a new state, as state laws and forms differ.

To update or cancel previous wishes, people usually need to fill out new forms following state guidelines. Tell doctors and agents about the updates right away and replace old versions. Destroy all outdated copies and give the latest version to everyone who needs it, including new doctors or care facilities.

When to Review Advance Directives	Example Situations
After big life events	Marriage, divorce, loss of agent
After major health changes	Diagnosis, surgery, terminal illness
After moving to a new state	Laws and forms may differ
On a regular schedule	Every year or during checkups

Medical Orders for Life-Sustaining Treatments

A Physician Orders for Life-Sustaining Treatment (POLST) form is a medical order that clearly states what kinds of life-saving treatments a seriously ill person wants or does not want. Unlike living wills, a POLST is a signed order and moves with a patient between hospitals, care homes, and emergency settings.

A POLST includes clear instructions for health workers about resuscitation, tube feeding, antibiotics, and how aggressively to treat new conditions. It is designed for people with severe illnesses or who are very close to the end of life.

Key Facts About POLST Forms

They are only for people with serious health problems or who may die soon.
A healthcare professional fills it out after talking with the patient or agent.
It has the force of a medical order and must be followed by health workers.
POLST forms can be changed or updated as care goals and situations change.

The POLST sits on top of other healthcare papers because it directs emergency and hospital teams on what to do right away. A POLST can work together with living wills and advance directives to make sure care matches each person’s wishes.

Table: Comparing Living Will, Power of Attorney, and POLST

Feature	Living Will	Power of Attorney	POLST
Who creates it	Person	Person	Person & healthcare provider
When used	When person cannot decide	When person cannot decide	During serious illness
Legal status	Legal document	Legal document	Medical order
Who follows it	Doctors, family	Agent, doctors	Healthcare workers
Focus	Treatments wanted/refused	Name agent to decide	Orders for emergency care

Having these forms in place helps everyone involved, from doctors to families, work together to honor a person’s health care wishes.