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"Advance Directives" and "Advance Health Care Directives" are the terms used to describe a group of legal documents which assure that your wishes about what medical treatments you do and do not want are carried out even if you lose the ability to make decisions yourself or become unable to communicate for yourself. 

It may be distressing to even think about writing an Advance Directive. However, without these documents:

  • You may be kept alive endlessly, at your expense, and against what you would have chosen for yourself. 
  • Someone may be appointed to speak for you who is not necessarily the person you would choose. As a general matter, even a person chosen to speak for you, including a person appointed by the court to act as a guardian, cannot end unwanted treatment unless you previously signed an Advance Directive.

Advance Directives are available for free for every state and can be written and executed without the help of a lawyer or other professional. They can easily be revoked or amended at any time. 

NOTE: Experience indicates that if you only have one Advance Healthcare Directive, it should be a Healthcare Power of Attorney.because it not only covers any conceivable situation, it also appoints someone to make sure your wishes are carried out even if the doctor or hospital disagree.with those wishes.

Types of Advance Directives

  • Healthcare Power of Attorney: A legal document in which you choose another person to make medical decisions on your behalf at any time you are unable to communicate yourself. You do not have to be terminally ill for the person to speak for you - just unable to communicate. (These documents are also called: Durable Power of Attorney for Healthcare, Healthcare Proxy, and Healthcare Agent. The person you appoint is referred to as your "agent" or "proxy".) For information about Healthcare Powers of Attorney, including who to choose as Proxy, click here.
  • Living Will: A legal document which only applies if you are both terminally ill and unable to speak for yourself.  A living will describes what you want to happen or not happen in the specific situations which are listed in the document. (Also known as: Directive To Physicians, and Healthcare Directive.) For information about Living Wills, click here.
  • Do Not Resuscitate Order (generally referred to as a "DNR"): A legal document which states you do not want to be revived if your heart or lungs stop working. A DNR does not apply if you merely have difficulty breathing. It also does not prevent any other medical treatments. Some states require a DNR order to be reauthorized periodically. For information about DNRs, click here.
  • Advance Directive for Mental Health: A legal document that provides for someone to make decisions for you if you become mentally incompetent and unable to make decisions yourself.  For information about Advance Directives for Mental Health, click here.
  • Advance Directive for Dementia: A legal document that relates to life- prolonging measures, including food and fluid, in the event of dementia. For a sample directive, click here offsite link.

Things to think about with respect to advance health care directives

  • Think about what medical care you do or do not want if you become unable to speak for yourself and and there is little or no hope of recovery. 
    • One alternative is to think through what you want to happen in various specific situations such as being placed on a respirator if there is no hope of recovery. Your doctor can help clarify medical questions about alternatives people with your particular medical condition may face. 
    • If you would prefer not to focus on the specifics, just think about what you want in general. For instance, "If there is no hope for my recovery, discontinue all extraordinary measures and machines. (Do) (Do not) continue to feed me."
    • For help thinking through the various matters to consider, see the form letter put together at Stanford University by clicking here. offsite link
  • If you only execute one advance directive, make it a Healthcare Power of Attorney. Even if you execute a Living Will, it is advisable to also have a HealthCare Power of Attorney. A Healthcare Power Of Attorney is the most important document for several reasons: 
    • First, major decisions in health care are seldom black and white. A Healthcare Power of Attorney provides flexibility. 
    • Second, a Healthcare Power of Attorney gives the person you appoint the right to enforce your wishes. This is important because studies show that doctors and hospitals often ignore a patient's wishes which are expressed in a Living Will. It is easier to ignore a piece of paper than a legally empowered person who is intent on having your wishes carried out. 
  • When you execute a Healthcare Power of Attorney:
    • Choose the person who will act as your Proxy with care.  
      • The person will have to deal with your doctor, the hospital and possibly your family. 
      • Sometimes the person will have to be aggressive in enforcing your wishes. Include contact information such as a mobile phone number.
      • To learn more about who to appoint as Proxy, click here.
    • Appoint an alternate in case your first choice cannot serve or cannot be reached for any reason.  The alternate should have the same qualities you look for in the primary Proxy.
    • Discuss what you do and do not want with your Proxy and Alternate Proxy. The discussion can just be about your general values and wishes. An understanding of your values will help them determine what you would want in areas that have not been specifically discussed. If you have specific wishes, let your Proxy and Alternate know that as well. For example, you do or do not want to be placed on a respirator if there is little likelihood you will ever live without one.
  • When you are ready to execute an Advance Directive:
    • Make sure that your documents follow the law of the state(s) in which you reside. Free state specific forms are available.
    • If you travel between states: Keep in mind that Advance Directives are state specific. While a document properly executed according to the laws of your own state should be recognized in another state, there is no guarantee. Be sure your advance directives are legal in each state in which you live and/or are likely to be treated. 
      • If necessary, execute duplicate Advance Directives - one for each relevant state. Be sure they do not have any provisions which conflict with each other. Have each document notarized even if it is not required in your state just in case you end up being treated in a state that requires notarization. 
    • If you execute both a Healthcare Proxy and a Living Will: Avoid conflicts by including provisions in each document which specifies which controls in the event of a conflict.
    • Discuss your wishes with your family. 
      • If the family fights your wishes, a time and money consuming court battle could follow.  Experience has shown that the more aware family members are of your desires, the more likely they are to be followed.
      • For information about how to talk with family about your wishes if you become incapacitated and cannot speak for yourself, click here.
      • If you execute a DNR directive, let your caregivers know not to call 911 if you stop breathing outside a hospital.
  • Once you have executed an Advance Directive:
    • Let your proxy and family know that Survivorship A to Z provides information about how to enforce your advance directives in case a doctor or medical facility do not go along with your wishes. If your Proxy reviews the information now, he or she will be able to act quickly and with less emotion if the need arises. 
    • Give a copy of your Advance Directives to each of your doctors.
    • Ask your doctor or other health care professional whether she or he agrees with your wishes or at least agrees to abide by them no matter what his or her personal beliefs. It also helps if the doctor is affiliated with a hospital that will accommodate wishes such as yours. 
      • It is better to bring up the issue earlier in the relationship with a doctor rather than later. While it is possible to switch doctors at any time, it can be difficult emotionally and can be disruptive to care. In addition, the closer a person is to end of life, it is reasonable to think that other doctors will be less likely to agree to sign on. 
      • Likewise, choosing the right hospital early can avoid a fight about enforcing your wishes or a transfer to another hospital that is more compatible to your wishes.
    • If you go into a hospital:
      • Consider also executing the advance directive forms used by the hospital. In the event of an emergency, hospital personnel will know precisely what to do if hospital forms are used. If you use your own form, hospital staff is likely to seek advice from the hospital's legal team which could delay action.
      • In any event, once in your room, check with a nurse on your floor to be sure the Advance Directives are included in your chart. If you executed a Do Not Resuscitate Order, be sure it is prominently noted throughout your chart so none of the people helping you can miss it. (Some people even put a sign that says "DNR" over their bed "just in case.")
      • Confirm with your attending doctor that he or she and the hospital will comply with your wishes. If he or she won't, consider switching doctors. (It is advisable to have your next doctor lined up before firing your current doctor). If the hospital will not agree to your wishes, consider asking that the hospital agree that you will be moved to a more agreeable facility if an event you care about happen.
    • Revisit your advance directives at least once a year.
      • You can easily amend or revoke any advance directive. All you need to do to revoke a directive is to rip it up. Alternatively, cross out the wording, write on each page: the word "revoked", the day's date and sign it.
      • If your advance directive is more than a few years old, the question can easily arise whether you changed your mind about the subject. Set a note on your calendar to remind yourself to revisit your advance directives. There is no need to create a new document unless your wishes have changed. You can indicate the wishes are current by adding the then current date and signing your name. 
      • Revisit your directives sooner if there is a significant decline in your health condition or there is a change in the relationship with your Proxy or Alternate Proxy.
    • If you are Catholic: the church has affirmed your right to make your own health care decisions.
    • In many states, if you named your spouse as your health care agent and you later become divorced or legally separated, your former spouse can no longer be your agent by law, unless you state otherwise.
  • In case you have a concern that discussing or executing advance directives will speed the end of life: A study published in 2011 found no significant differences in survival for participants at low and medium risk of death who reported having had an Advance Directive and those who had not, and for those who had an Advance Directive in the medical record vs those who did not.

What to do with your Advance Directives 

Advance Directives are only meaningful if the appropriate people know about them.

  • Give a copy to your primary doctor and each doctor who will oversee your care in what could be a life-threatening situation. This includes doctors who will perform an out patient procedure which involves anesthesia.
  • Give a copy to each person you believe will help enforce your directives.
  • If you have an online personal health record, file a copy with your record.
  • Carry a card in your wallet to let people know you have Advance Directives and where to find them.

Store the originals of your Advance Directives in a safe place which is easy to access.

  • Let the people who are charged with enforcing your Advance Directives know where the originals are.
  • To learn about where to store (and not store) your other important documents, click here.


POLST stands for Physician Orders for Life-Sustaining Treatment Paradigm. POLST is a program for people with an advanced terminal illness. POLST is in addition to the above mentioned advance directives - not instead of any of them. POLST starts with a discussion between the patient and treating doctor about the patient's end-of-life wishes. The result of the conversations are written into a POLST form which becomes a medical action order. The idea is to be sure that a patient's wishes are followed. To learn more about POLST, including whether POLST is available in your state, go to offsite link

Frequently Asked Questions

NOTE:  When considering documents to cover the "what ifs" also consider executing an Advance Directive for Mental Health which covers what happens if you become mentally incompetent and a Durable Power Of Attorney, which covers your finances. Also be sure you have a valid Will. Everyone needs a Will. To learn about Wills, including low cost or free wills, click here. To learn about how to make a will challenge proof, click here

The Catholic Church's Position On Advance Health Care Directives

According to the Catholic Health Association of the United States:

"The church has not spoken directly on advance directives, but it has affirmed a patient’s right to make his or her own health care decisions. The 1980 Vatican Declaration on Euthanasia recognizes the patient’s right to make decisions about withholding or withdrawing treatment (excluding physician-assisted suicide and euthanasia) in collaboration with family members and physicians. So does the Catechism of the Catholic Church which states: “The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected” (#2278).

In addition, the Ethical and Religious Directives for Catholic Health Care Services (ERDs), a document issued by the United States Conference of Catholic Bishops that guides the practice of Catholic health care organizations, recognizes the right to execute an advance directive and appoint a surrogate decision maker (Directives 24 and 25). The ERDs also state that a person's advance directive should be followed so long as it does not request anything contrary to church teaching (such as physician-assisted suicide)."

Where Can I Find Free Advance Directive Forms?

There are many sources for free, state specific, Advance Directives. Following are a few reputable places. Please feel free to tell us about additional sources to share with other people in a similar situation.

  • Caring Connections offsite link  Click on Download Your State Specific Advance Directive or call 800.658.8898
  • Compassion and Choices, offsite link, click on "Plan Your Care", then "Tools To Manage Your Care" or call 800.247.7421
  • Hospital admitting departments.
  • State and local bar associations. You can locate the associations in your state via offsite link
  • If you are facing the reality of dementia, whether due to Alzheimer's Disease or other causes, see an advance directive specifically dealing with this issue at offsite link.  

NOTE: There are expanded Living Wills which include your wishes for level of comfort, including the kind of music you would want played. An example is the form known as Five Wishes which is available for a small fee at offsite link. While these forms can be helpful in detailing your wishes, they may be confusing to doctors who are used to the standard form used in your state. If you use one of these forms:

  • Show it to your doctor to be sure he or she understands it.
  • If you are going to enter a hospital, also complete the forms used by the hospital.  Forms other than the ones commonly used by the hospital will likely have to be interpreted by the hospital's lawyers and that could unnecessarily hold things up.  (Make sure what you say in the two forms is not in conflict). 

Why Do I Need A Living Will and/or A Health Care Proxy?

A Living Will and/or a Health Care Power Of Attorney are needed to prevent the following from happening: 

  • You may be kept alive endlessly at your expense.
    • Doctors and health care facilities will do everything they can to keep you alive.  It's what doctors are trained to do. They may even be required to by state law unless you have clearly expressed a contrary desire. It is also in their financial self interest to keep you alive  and treat you as long as possible.The result is you may be subjected to unwanted, prolonged, and expensive treatment - and the likelihood that you or your estate will have to pay for it.
    • Quality of life is not their concern. Keeping you alive is. In fact, there may be no practical end to the treatment. For instance, in the Terri Shiavo case, think about how many years she was kept alive on machines even though it was later proved that her brain was no longer functioning.
    • Courts (and most health facilities) require clear and convincing evidence that the patient expressed a desire to forego life sustaining treatment while competent. Proving that a person made clear statements can be difficult and can result in expensive, time consuming litigation. Litigation can be started by family members who may be divided or uncertain about your wishes. It can also be started by the health care provider if a doctor or hospital has doubts about your wishes and/or whether the procedures/proof required in your state were followed. Advance Directives provide the required proof.
  • Someone will be appointed to speak for you who is not necessarily the person you would choose.
    • Most states have "Surrogate consent" laws which determine who makes medical decisions for you in the event you can't speak for yourself. Generally, the named people are legal relatives, starting with a spouse. The laws do not take into account whether the person knows your wishes, or whether he or she would honor them even if the person knows your wishes.
    • In those states without Surrogate Consent laws, the courts determine who has the authority - not you.
  • As a general matter, even a person chosen to speak for you cannot end unwanted treatment.
    • Even when it is settled who can speak for you, hospitals and other health care facilities can be reluctant to end treatment unless there is clear and convincing evidence of your desires. The result can be expensive, public, stressful litigation to compel what the family believes you would have wanted can result.
    • If the family can't prove the incapacitated person's desires to the Court's satisfaction, unnecessary funds are expended and treatment the incapacitated person would not have wanted is given and/or extended. 
  • There may be conflicts with the health insurance provider.
    • An insurance provider may move to stop payment because of lack of evidence that you wanted to continue treatment in the circumstances.
  • There may be disagreements within a family.
    • Unless you appoint a health care Proxy and/or make your wishes clear in writing, family members can battle for a long, expensive time. In the Terri Schiavo situation, she had told her husband what she wanted if she became incapacitated and unable to speak for herself. She didn't put her wishes in writing. Family members went to court and stayed there for many, expensive years.. 

To Learn More

More Information

Surrogate Consent Laws

Why Do I Need A Healthcare Power of Attorney If I Have A Living Will?

It is important to have a Healthcare Power of Attorney even if you have a Living Will for the following four reasons:

1. The person named in a Healthcare Power of Attorney has flexibility to make decisions based on the specific circumstances of your condition and situation. In addition to making major decisions such as withholding life-extending treatment, a Healthcare Proxy can also make decisions in temporary situations for urgently needed care such as hospitalization or surgery.

2. A Healthcare Power of Attorney appoints a person you trust to enforce your wishes and on a timely basis. A Living Will only expresses your wishes. It doesn't appoint someone to enforce them. In a high percentage of cases, doctors ignore advance directives.

3. A Living Will is limited and inflexible because it only spells out your specific wishes regarding specific procedures in the event of your incapacity at the end of life. The effectiveness of a Living Will is limited.

  • A Living Will only covers those situations which are specifically covered in the document. 
    • Living Wills tend to describe wishes in black and white situations. Reality is generally more grey.
    • Like most documents, a Living Will cannot anticipate every possible scenario or future changes in medical practice.
  • The doctor has to take the time to study the document and try to understand your intent. This can be difficult in a stressful clinical environment in which there are times when every second counts. 
  • There can be questions as to the meaning of words that seemed clear at the time the document was executed, but which are not so clear when it is time to use the document.
  • Doctors can fear lawsuits even when state laws protect them from liability if they comply with a valid advance directive in good faith.

4. Last, but not least, if you have a Health Care Power Of Attorney, the burden is removed from the doctor. With a Living Will, your doctor is put in the position of having to make a decision about what you would want in the particular situation.

To Learn More

More Information

Living Wills

Why Do I Need A Do Not Resuscitate Directive (DNR) If I Have A Living Will And/Or A Health Care Power Of Attorney?

A DNR order is a doctor’s written order that instructs other healthcare workers not to attempt to revive a patient (resuscitation) if a patient’s heart or lungs stop working. If this order is not written, it is assumed that Cardio Pulmonary Resuscitation (CPR) is wanted, no matter what the condition of the patient.

A person can say in a Living Will that CPR is not wanted but this will not stop CPR until the doctor has written the order.

A Healthcare Proxy could ask a doctor to issue a DNR, but the doctor may not be as agreeable to going along with the request as he or she would be if you and the doctor had the discussion. After all, the doctor would be aware that you knew enough about Advance Directives to execute a Healthcare Proxy which likely meant you also knew about a DNR, but that you didn’t sign one.

What If I Move Or Receive Treatment In Another State?

Virtually all states have laws permitting advance directives, including living wills, appointment of healthcare proxies, and DNRs. However, they do not all have the same requirements and provisions. Very few state laws provide for what happens if documents are created and executed under another state's jurisdiction and laws.

Although some states may honor out-of-state documents, to be safe, we suggest that you:

  • Execute each Advance Directive in front of a notary public even if it isn't required in the state in which you live. This way, if you happen to be in a state which does require notarization if an event occurs, the documents will be valid.
  • Execute a new set of Advance Directives for each state in which you receive treatment - whether it's due to a permanent move or simply a temporary stay for treatment. The forms aren't complicated, are free and are not difficult to execute.

To avoid any conflict between more than one set of documents:

  • Any directive for a state in which you do not live should mention the prior document and state that the purpose is not to replace the old document (which you expect to still be valid under the law of the state in which it was executed), but simply to conform to the law of the state in case you become incapacitated in that state.
  • If you have more than one Healthcare Power of Attorney, do not appoint different people to be the proxy. With communication today, a Proxy can be available regardless of where you are.

In case of conflicts, we encourage you to seek legal counsel if you decide you need more than one set of Advance Directives to conform to different state laws.

To Learn More

How To Choose A Doctor Who Will Comply With Your Wishes

One of the critical elements when choosing a doctor is to be sure he or she agrees with your wishes about what you want done if you become incapacitated and can't speak for yourself. In fact, it would be helpful to discuss your wishes with your doctor before you write a Living Will, Healthcare Power of Attorney and/or DNR to get his or her input about:

  • Situations you may face because of your health condition and related life support systems.
  • Clinical terms that may help make a Living Will more effective, and discussions with a Healthcare Proxy more fruitful.

If the doctor doesn't agree with your beliefs, the question becomes whether he or she will agree to nonetheless carry them out. If the answer is "no" - find another doctor.

Likewise, if the only hospital the doctor can work in (has "privileges" in) has a policy of continuing life no matter what - either find another doctor or get your doctor's agreement that if something happens to you, you will be sent to a hospital that will follow your wishes - even if it means that doctor cannot attend to you in that hospital.

For information about the following topics, click on the link:

Be sure to give the doctor a copy of each of your Advance Directives and ask that they be kept in your medical record. Also give a copy to each specialist you see.

What If My Healthcare Proxy's Decision Conflicts With The Instructions In My Living Will?

It is possible that a decision about your healthcare by your Healthcare Proxy will conflict with instructions in your Living Will. While it is always possible that the two will give directly opposite instructions, more than likely it will occur due to your Living Will being unclear in the instructions or the circumstances surrounding your medical condition. It is also possible that your Healthcare Proxy may not have completely understood your wishes.

Obviously such a conflict could result in a lengthy delay in implementing your instructions while a court resolves the conflict.

If the matter goes before a court, the judge will weigh the wording of the Living Will and the reasoning of the Proxy. The judge will also look to other factors which may include the desires of family and relatives, which could include people you do not wish to be part of the process.

To avoid such a conflict and resulting delay, there are several steps you can take when drafting the documents:

  1. Check your state law and see if it permits a Living Will and Healthcare Power of Attorney to be merged into one document which can address the conflict issue should it arise. For instance, California permits such a merger.
  2. Even if combining the documents into one is not possible in your state, make clear in both documents your intent as to whether you want your Living Will or your Proxy to have the final power over the other.
  3. Work with an advisor or legal counsel to make sure your Living Will is clear in its instructions with as little ambiguity as possible.
  4. Spend time talking with your Proxy to make sure he or she has a clear idea of your desires and is familiar with the wording and the intent behind your Living Will instructions.

How Long Do Advance Directives Stay In Effect?

Advance Directives stay in effect indefintely. There is no cut off date unless you include one in the form or describe circumstances in which they would automatically terminate.

As noted below, you can cancel or change your advance directives at any time.

NOTE: It is advisable to review your Advance Directives at least once a year to be sure they continue to reflect your wishes.

How To Choose A Hospital Or Other Health Care FacilityThat Respects Your Wishes

All hospitals will give you Advance Directive forms to complete when you check in. That doesn't necessarily mean they have a record of following them.

If there is a question about a hospital's practices:

  • Your doctor or his or her staff likely knows the answer or can easily find out.
  • Call the head of patient relations and ask him or her. If it is not clear with whom to speak, ask for the President. His or her assistant will likely be able to direct you to the right person.
    • Let the person know about your wishes.
    • Ask if the facility will agree to your wishes.
    • If the facility is agreeable to your wishes, note the date, the person's name and contact information and give a copy to your Proxy and alternate.

NOTE: If you really want to be prepared,  pick and interview a lawyer who is qualified with knowledge of this aspect of the law and experience. You will be assured your directives will be enforced and your Proxy won't have to waste time looking for an appropriate attorney. The legal specialty is known as "Elder law." You can locate an Elder Law lawyers through  offsite link

For information about to choose a hospital in general, click here.

How To Talk With Family About Your Wishes About What To Do If You Become Incapacitated And Can't Speak For Yourself

Talking about the possibility of incapacitation is not an easy topic for your family and friends any more than it is for you. However, it is up to you to take the initiative and express your wishes.

Since you have been diagnosed with a serous health condition, people who care about you are likely to think the discussion morbid. You can make the discussion easier by taking the focus off of you. For example, make the discussion about what each of you want in case any of you become incapacitated and unable to communicate or is suddenly in an end-of-life situation. After all, as we see every day on the news, anything can happen to any of us at any time.

A holiday or other family gathering is a good time to have the discussion. The override of the reason for the gathering can help keep the discussion in perspective.

If it's easier, or there is a time sensitive situation in which the risk of something happening is increased such as entering a hospital for an operation, have the discussion one-on-one with family members.

It may help to focus the discussion on your general values, personal concerns and religious or spiritual belief instead of specific treatments or circumstances.For example, talk about:

  • What you value most in life. For example, living a long life, or living an active life.
  • How you feel about death and dying. For example, do you fear it? Did someone else's death affect your thinking?
  • How important is it to you to be physically independent?
  • Would it matter how your health condition affects your finances?  How it affects other people?
  • How much pain and risk would you be willing to accept if your chances of recovery from an illness or an injury were 50/50 or better? If your chances of recovery were poor, say less than 1 in 10?
  • Do you have religious or spiritual values that affect what you think about any particular treatments, death, or dying?
  • Other beliefs or values you have that should be considered when people make medical decisions for you.
  • How do you feel about dying at home instead of somewhere else?

The discussion is an opportunity to find out whether other people close to you have executed Advance Directives. If they haven't, encourage them to do so. Set a deadline to help people to act.  


Who Should I Give Copies Of My Healthcare Power Of Attorney, Living Will and Do Not Resuscitate Order?

Advance Directives are meaningless if the right people aren't aware that they exist when they are needed. 

Living Will and Do Not Resuscitate Order (DNR)

Give a copy of your living will and DNR to each of the following:

  • Appropriate family members who are likely to be accessible and aware of your condition should you become unable to communicate.
  • Your Healthcare Proxy and alternate Healthcare Proxy if you have designated one. (f you haven't, please consider doing so.)
  • Each of your medical providers, including every specialist and your primary treating doctor.
  • Any other health care providers that may need to be aware of its existence, such as home health services.
  • Every medical facility you enter, such as a hospital or nursing home. (Be sure the copy is entered into your medical record.)


  • Keep a copy with your valuable papers, and one in your Emergency Tote Bag in case you go to the hospital in a hurry.
  • Keep a copy of your Living Will and or DNR, or at least a card or notation that you have such documents and how to find them quickly, in your wallet in case you travel or in case of an unexpected trip to the emergency room.
  • Consider using the American Bar Association's smart phone app which allows you to carry your directives with you in your phone so they are immediately available for emergencies or any time you interact with the health care system. To learn about the app, click here offsite link.

If your state requires a bracelet to effectuate a DNR, it is advisable to wear the bracelet.

If you have a DNR:

  • In case you have an emergency at home, in order to avoid emergency personnel going against your wishes, consider posting the DNR in a place where any emergency personnel will see it. 
  • Also consider instructing your caregivers not to call 911. If they call, emegency personnel are usually required to do what they can to revive you, even if they are handed a copy of a DNR.

Healthcare Power Of Attorney 

Give a copy of your healthcare power of attorney to all of the above plus:

  • Your pharmacist (to permit an exchange of information with the person named as your Proxy without worry about invasion of your privacy)
  • Your attorney in case any questions are asked about the person's authority to act.

Keep a list of the people to whom you give a copy of your Advance Directives in case you later revoke or change any of them. If you keep the list with your important papers, you'll always know where it is. Consider keeping the list in THE Book. (For more information on THE Book, see "To Learn More.")

You can register your Living Will online to make it easier for people to access. Registration assures a copy can be found when needed. It is also helpful if you travel.

Google Health has a free online registration service at offsite link.

You can also register your Living Will and other Advance Directives for a fee at an online service such as U.S. Living Will Registry ( offsite link Tel.: 800.548.9455 or MedicAlert, offsite link

How Often Should I Revisit My Advance Directives?

Things change -- including our beliefs and our relationships to people.

To avoid the problem of medical personnel questioning whether a document which is years old still reflects your wishes, it is advisable to re-execute your documents every year. If not every year, at least every two years. The re-execution can be as simple as signing your name to the document again and adding the date.

It is also a good idea to revisit your documents: 

  • If there is a significant change (for better or worse) in your health condition.
  • If you or an appointed decision-maker change opinions about treatment
  • People you know or people in the news experience a situation which could be covered by an Advance Directive and you want to check to see how your documentation would cover the situation.

If your views change, rip up the old document, execute a new one, and give it it to the appropriate people. Let everyone who has a copy of your old directives know there are new ones.

It is also advisable to speak with the people you appointed as Proxy and as Alternate at least once a year to remind them of your wishes and to be sure they are still agreeable to (and capable of) doing what you want.

NOTE: Consider setting a date on your calendar to remind you to revisit your Advance Directives. Roll the reminder from year to year.

How To Revoke Or Amend A Living Will, Healthcare Power Of Attorney Or DNR (Advance Directives)

This discussion is divided into amendment (changing what is in a document), revocation (terminating it) and who to inform about an amendment or revocation.


If you want to amend an Advance Directive, do it with the same formality as required in the state to execute the document. For instance, if two witnesses are required, write your amendment on the document in ink, sign next to the change and have the witnesses sign their names as well.

Make sure you amend each copy - not just one. Because of this, it may be easier just to go ahead and execute new Directives.

NOTE: It is advisable to execute your documents in front of a notary public even if not required by the laws of the state in which you reside. While most states do not require notarization of Living Wills, there are some states which require notarization to make them effective. If you execute your document in front of a notary, you are covered in case you are traveling and something happens in another state 


You can revoke an Advance Directive just by ripping-up each copy. Alternatively, you can cross out the substance in each copy, add the date, and sign it.

Inform The People Who Have A Copy Of Each Document. Send an email.

Let each person who has a copy of the directive know you have changed or revoked it. If you have amended a document, give them a copy of the amended document. Preferably also e-mail each person so there is a paper trail if it is ever needed.

It will also be helpful to let people who know about your wishes, but don't have a copy of the documents.

How Is Incapacity Determined?

Incapacity is generally determined by an attending physician (the doctor taking care of you or a specific health condition.).

The doctor looks to determine whether (with a reasonable degree of medical certainty), the patient has the capacity to make decisions about his or her own medical treatments.

When life sustaining treatments are involved, a second doctor usually has to confirm the opinion.