What are Advance Directives?
Advance directives only take effect when the person can no longer make medical decisions on their own.
When someone is very sick or close to dying, they may not be able to make medical decisions or speak for themselves.
Advance directives are legal papers that explain what kind of medical care a person wants in the future, before they become too sick to decide or communicate. These papers help make sure the person gets only the care they want and doesn't get care they don't want.
Surrogate in Healthcare Decisions
A very sick person may need someone else to make medical decisions for them. This trusted person is called a “surrogate” decision maker.
The surrogate’s role is to make decisions the way the sick person would want, not based on the surrogate’s own wishes.
Your expressed wishes are legally and ethically more important than what others want for you, even if they feel that they are acting in your best interests.
Types of Advance Directives
Two common types of advance directives for health care are:
- Living wills
- Durable power of attorney for healthcare.
States have different names for this, including healthcare proxy or healthcare declaration.
Living Wills
A living will lets a person explain how they want to be medically treated if they are too sick to stay alive on their own.
Some treatments that help keep people alive include:
- CPR (which may help if the heart stops)
- A machine that helps with breathing (such as breathing tubes or ventilators)
- Getting food in a special way (such as a feeding tube or IV)
In some states, a living will can also name a surrogate decision maker. Doctors and caregivers who follow a valid living will are protected by law.
Durable Power of Attorney for Healthcare
This legal document allows a person to choose a surrogate decision maker, such as a friend or family member. The surrogate makes medical decisions when the person can no longer do so. This document is more flexible than a living will.
The best surrogate decision maker is someone who knows the person’s healthcare wishes and is willing to act in the person’s best interest.
Physician Orders for Life-Sustaining Treatment (POLST)
A POLST is for people who have a serious illness, are very frail, or are very old.
- A POLST form gives healthcare professionals medical orders they must follow based on the person’s choices.
- POLST forms can be used in different healthcare settings, including emergency services, hospitals, and nursing homes.
- Because a POLST contains medical orders, it must be discussed with a doctor and signed to be valid.
- POLST forms are usually printed on brightly colored paper and should be kept in a visible place at home, so emergency responders can easily find it.
Visit the National POLST Program website to learn more and find programs in your state.
Changes to Advance Directives
Advance directives may need to be reviewed when a person:
- Experiences a change in health
- Enters or leaves a hospital or nursing home
- Chooses a new surrogate
A person can change or cancel an advance directive at any time if they can still make decisions.
Healthcare professionals are legally required to follow advance directives as much as possible.
Family Role in Decision Making
Advance directives can help people and their families by:
- Improving quality of life
- Letting them choose where to die and avoid unwanted treatments
- Lowering stress at the end of life
Rules for Surrogate Decision Making
Most states and the Department of Veterans Affairs follow an order for who can make healthcare decisions:
- A legal guardian
- A surrogate named in a durable power of attorney for healthcare
- A spouse
- Other family members. Some states allow for non-family surrogate decision makers who know the sick person well.
When no legal surrogate decision maker exists, healthcare professionals may decide that family members cannot make medical decisions. For example, families may have:
- Different personalities, values, or interests
- Estranged family members
- Disagreements among family members
- Family members who are unable or unwilling to make decisions
These are some of the reasons why it is important to complete an advance directive and choose a surrogate before you become ill.
If no legal surrogate exists, healthcare professionals may ask a court to appoint a guardian. (see: Guardianship).
Limits of Advance Directives
Advance directives have limits. People may not fully understand options, may change their wishes, or may write directions that are too unclear.
Talking about wishes early and often with your healthcare professional and each other can help prevent these problems.
Importance of Communication
Good communication with healthcare professionals and a surrogate helps prevent problems.
A question you can ask: “Can we talk about how decisions will be made for my medical care if I become too sick to speak for myself?”
Ask or tell your healthcare professional about:
- Situations that may happen with your specific illness or condition
- Different treatment options, including the care you want and the care you do not want
- Your wishes, including who you choose as your surrogate decision maker
- The limits of the surrogate’s decision-making power and how you will tell them if you change your mind
Last Reviewed and Updated: October 2026
By: AGS/HiAF Public Education Committee, HealthinAging.org Content Reviewers