What is advance directive?

The two most common types are a living will, which lists specific treatments wanted or not wanted (CPR, mechanical ventilation, tube feeding, dialysis, antibiotics, comfort/palliative care, organ donation), and a durable power of attorney for health care (also called a health care proxy, agent, or surrogate), which names a trusted person to make medical decisions on your behalf. People may have one or both. Related but separate tools include DNR (do not resuscitate) and DNI (do not intubate) orders, which are written into a medical chart by a healthcare professional after discussing your preferences with you, and POLST/MOLST forms used near the end of life.

Advance directives are legally recognized but not always legally binding in practice — a provider may decline to follow them if doing so conflicts with conscience, institutional policy, or accepted medical standards, in which case they're expected to notify the health care proxy and consider transferring care. Requirements for creating one (forms, witnesses, notarization) vary by state, so it's worth checking state-specific rules, for instance through a state bar association or organizations like the National Hospice and Palliative Care Organization.

Without an advance directive, state law determines who can make medical decisions on a person's behalf if they become unable to communicate — typically a spouse, parent, or adult child, though rules and default hierarchies differ by state. Because gaps and disagreements can arise, advance care planning experts recommend reviewing and updating these documents periodically, sharing copies with family, providers, and the named proxy, and discussing wishes directly with loved ones.