Advance Directives & Health Care Power of Attorney Guide

When a parent lands in the hospital unable to speak for themselves, the question of what they would have wanted falls to whoever is standing in the hallway. Advance directives answer it ahead of time: a living will records the treatments your loved one would or would not want, and a health care power of attorney names the proxy who can decide for them. Putting both in place while there is still time and calm is one of the most loving things a family can do.

This guide explains the two core advance directives, the medical orders that go further, what happens to a family without them, how the documents actually work when a crisis hits, and how to set them up.

Why Advance Directives Matter Before a Crisis

Advance care planning means deciding in advance the health care you would want if a serious illness or injury left you unable to speak for yourself, and putting those wishes in writing, as the National Library of Medicine's MedlinePlus explains.1 The point is not paperwork. It is that the people who love them are not left guessing during the worst week of their lives.

If you are caring for an aging parent or spouse, helping them complete these documents while they can still express their wishes is a gift to everyone who will one day have to act on them.

The Two Core Advance Directives

There are two core advance directives for health care: one states the wishes, the other names the person.1

• A living will. This is a written document stating which medical treatments a person would or would not want to sustain life if they cannot make decisions, for example CPR, a breathing machine, tube or IV feeding, dialysis, or blood transfusions.1 It speaks for the person when they cannot speak for themselves.
• A durable power of attorney for health care. This names a trusted person, the health care proxy (also called an agent, surrogate, or representative), to make medical decisions on the person's behalf when they cannot make them.1 A living will cannot anticipate every situation; a named proxy can apply the person's values to whatever actually comes up. When you name a proxy, name one or two backups as well, so someone can still step in if your first choice cannot be reached.2

Together they cover both the "what" (the living will's instructions) and the "who" (the proxy who can decide in real time).

Medical Orders for Serious Illness

For someone who is seriously ill or near the end of life, there are additional documents that go a step further than advance directives, because they are medical orders that health care professionals can act on immediately in an emergency.1

• A do-not-resuscitate (DNR) order tells providers not to perform CPR if breathing or the heartbeat stops.1
• A do-not-intubate (DNI) order says the person does not want to be placed on a ventilator.1
• A POLST or MOLST form (Physician or Medical Orders for Life-Sustaining Treatment, sometimes called portable medical orders or POST) gives guidance about care that health care professionals can act on immediately in an emergency, and it serves as a medical order in addition to the advance directive.1

These medical orders work alongside an advance directive rather than replacing it, and a POLST or MOLST is typically created when a person is near the end of life or critically ill.1 These forms are not available everywhere, so check with your state department of health to find out whether they are offered where your loved one lives.1

How Advance Directives Work in Practice

It helps to know how these documents actually operate, because a lot of the worry comes from not knowing. A directive does not take away anyone's voice while they can still use it. Advance directives go into effect only if the person cannot communicate their own wishes.1

At that point, the health care proxy steps in. The proxy is the decision-maker, not a bystander: they make medical decisions on the person's behalf, guided by what the living will says and by what they know the person would have wanted.1 What an agent can do differs by state; in most states it includes choosing or refusing life-sustaining and other medical treatment, but before naming anyone, find out whether your state lets an agent refuse or stop tube feeding or other life-sustaining care that the directive does not address.2 For example, if your mother is sedated after surgery and cannot communicate, her proxy is the one the care team turns to about next steps, using her living will as the guide.

One practical point families miss: these documents are not self-executing. Someone has to put them in the providers' hands. Giving copies to the doctors and the hospital ahead of time, rather than searching for them mid-crisis, is what lets them actually be honored.1

What Happens Without an Advance Directive

This is the part that makes the stakes concrete. If your loved one has no advance directive and is unable to make decisions, the choice does not simply fall to whoever is closest. The laws of the state where they live determine who may make medical decisions on their behalf, typically a spouse, parents if they are available, or adult children.2 An unmarried partner who was never named as proxy could be excluded from decision-making.2 For someone with no family, some states allow a close friend who is familiar with their values to help, or may assign a physician to represent their best interests.2 If no one eligible is available or willing, or family members disagree, who decides is a question of that state's law.2

Completing an advance directive is how a family keeps that decision where it belongs, with the person and the people they trust, instead of leaving it to a state's default rules.

A Health Care POA Is Not a Financial POA

One common point of confusion: a durable power of attorney for health care is different from a financial power of attorney.1 A health care agent has no control over the person's money and cannot be made to pay their bills; managing financial or personal affairs takes a separate power of attorney.2 Our guide to guardianship vs. power of attorney explains which one a parent needs, and a separate guide covers whether a power of attorney ends at death.

How to Set Up Your Advance Directives

The paperwork is usually simpler than the conversation, so take a breath before you start. A few things worth knowing:

• They are state-specific. Each state has its own laws regarding advance directives, and most states require a witness to be present at the signing, so follow the law of the state where your loved one lives or is being treated.1 CaringInfo provides free advance directives with instructions for each state.1
• A document from another state may not transfer. A living will or durable power of attorney accepted in one state may not be accepted in another, so if your loved one moves or spends part of the year elsewhere, confirm the documents meet each state's requirements.2
• Name a primary proxy and a backup. Choose the person you trust to decide, then name one or two alternates in case your first choice can't be reached when needed.2
• They take effect only when needed. Advance directives go into effect only if the person cannot communicate their own wishes, and they can be changed or canceled at any time.1
• Distribute copies. After signing, give copies to the person's doctor, the hospital, and family members, so the right people have them when it matters.1

The conversation is often harder than the paperwork. Approach it gently, more than once if needed, framed around making sure the person's own wishes are the ones that get followed.

Free Resources Worth Saving

FAQ

Learn More

Find personalized help with caregiving and care planning at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.