How Do You Write an Advance Directive or Living Will? A Step-by-Step Guide

The short answer: An advance directive (also called a living will or healthcare directive) is a legal document that records your healthcare wishes for situations when you can't speak for yourself. Creating one involves identifying your values, completing a state-specific form, having it signed and witnessed or notarized, and sharing it with your doctor, family, and healthcare agent.

What Is an Advance Directive?

An advance directive is a legal document (or set of documents) that tells doctors and family members what medical treatment you want — or don't want — if you become unable to communicate your wishes. It typically includes two components:

Healthcare Power of Attorney (HCPOA) / Healthcare Proxy: Names a specific person to make medical decisions on your behalf
Living Will / Instruction Directive: Documents your specific wishes about treatment — life support, resuscitation, artificial nutrition, etc.

Together, these documents ensure your wishes are known and legally enforceable across healthcare settings.

Step 1: Clarify Your Values and Wishes

Before completing any form, reflect on what matters most to you:

What makes life meaningful for you? What quality of life is acceptable?
If you were in a permanent coma with no chance of recovery, what would you want?
If you had advanced dementia and didn't recognize family, what care would you want?
Do you want CPR attempted if your heart stops? Under what circumstances?
Do you want to be on a ventilator (breathing machine) long-term if there's no hope of recovery?
Do you want artificial nutrition (feeding tube) if you can't eat?
Where do you want to die if possible?

Step 2: Choose a Healthcare Agent

Your healthcare agent (also called healthcare proxy or healthcare power of attorney) is the person who will make medical decisions for you. Choose someone who:

Knows your values and will advocate for them, even under pressure
Can remain calm in a medical crisis
Is available and geographically accessible
Is willing to accept the responsibility

Tell them your wishes in detail — the written document alone is less effective than a person who deeply understands your values.

Step 3: Complete Your State-Specific Form

Advance directive forms are state-specific. Use the form for the state where you primarily receive medical care. Free state-specific forms are available from:

Five Wishes (fivewishes.org) — widely used, narrative format, valid in most states
Prepare for Your Care (prepareforyourcare.org) — guided online tool
Your State Department of Health — official state forms
Caring Connections (caringinfo.org) — NHPCO's free state forms

Step 4: Sign, Witness, and Notarize

Requirements vary by state but typically require:

Your signature (or signature of someone at your direction)
Two witnesses (who cannot be your healthcare agent, relatives, or heirs)
Notarization (required in some states, optional in others)

Check your specific state's requirements carefully.

Step 5: Distribute and Register

Give a copy to your healthcare agent
Give a copy to your primary care physician and specialist(s) — ask them to put it in your medical record
Keep a copy with your important documents at home
Carry a summary card in your wallet
Consider registering in a state advance directive registry if available
For those with serious illness: complete a POLST form with your physician

Frequently Asked Questions

Is a living will the same as an advance directive?

A living will is one component of an advance directive. The term 'advance directive' is an umbrella term that typically includes both a living will (your specific treatment wishes) and a healthcare power of attorney (naming someone to make decisions for you). In common usage, the terms are sometimes used interchangeably, but a comprehensive plan includes both documents.

Does an advance directive need to be notarized?

Requirements vary by state. Some states require notarization; others require only two witnesses; some accept either. Check your specific state's requirements. Free state-specific forms from caringinfo.org or fivewishes.org include the specific signing requirements for each state.

Can I write my own advance directive without a lawyer?

Yes. Advance directives do not require a lawyer and can be completed using free state-specific forms. Many people complete them independently. A lawyer can be helpful for complex situations or if you want the document integrated with other estate planning. Death doulas are also trained to help with advance directive conversations and completion.

What happens if I don't have an advance directive?

Without an advance directive, medical decisions default to next-of-kin in a state-specific hierarchy (usually spouse, then adult children, then parents, etc.). If family members disagree, decisions may require court involvement. Medical providers may default to more aggressive treatment. Having no advance directive means your specific wishes may not be known or honored.

How often should I update my advance directive?

Review your advance directive every few years, after major life changes (new diagnosis, death of healthcare agent, change in values), and after any significant hospitalization. An advance directive doesn't expire, but your wishes may change over time. If you revise it, destroy old copies and distribute the updated version to everyone who has a copy.

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