Advance Directives: Medical Decisions You Make Now

What's Actually Happening

Medical emergencies strip away your autonomy. You have a stroke, go unconscious, and cannot tell doctors what you want. Doctors are trained to preserve life—they'll resuscitate, intubate, use feeding tubes, and fight death with every tool they have. But maybe you don't want that. Maybe you want comfort over intervention. Maybe you want to die at home, not in a hospital, with pain management but not heroic measures. The only way doctors know this is if you told them, in writing, before the emergency.

A healthcare proxy (also called a medical power of attorney or healthcare surrogate) is the person you name to make medical decisions for you if you can't. A living will is your written statement of what kind of treatment you do and don't want. Together, they're called advance directives. Both matter. The proxy matters because they know you and can make judgment calls (the living will can't cover every scenario). The living will matters because it tells your proxy and your doctors what your values are.

Without advance directives, hospitals follow default protocols: code blue means resuscitate, injury means intervene, serious illness means treat aggressively. If your family disagrees about whether to continue life support, you have a legal and emotional disaster. Mom is on a ventilator with no brain function; the kids fight about whether to pull the plug; the hospital won't turn off the machines without either a directive or a court order; it drags on for weeks, costs tens of thousands in hospital bills, and tears the family apart. This happens in American hospitals constantly.

The conversations are uncomfortable. Talking to your adult kids about whether you want to be resuscitated if you're 90 and have advanced dementia feels morbid. But the alternative—your kids arguing with each other and with doctors while you're unconscious—is far worse. The families who have these conversations report feeling relieved, not sad. They know what their parent wants, and they're not guessing or fighting later.

Advance directives are state-specific. Some states call it a living will, some call it an advance directive, some use healthcare proxy or healthcare surrogate. The legal requirements differ. A form valid in Florida might not be valid in California. You need your state's official or approved form, not a generic template off the internet.

What No One Told You

Healthcare Proxy is Different From Financial Power of Attorney

People sometimes confuse their financial POA (who manages bank accounts) with their healthcare proxy (who makes medical decisions). These are different people, and you may want different people in each role. Your trusted financial person might not be the person you want making life-or-death medical decisions. Your sibling who knows your values best might not be organized enough to handle finances. You can name different people and should think intentionally about each role.

Living Will Specifics Matter—And Most People Get Them Wrong or Too Vague

A living will should specify what you want about: resuscitation (CPR), intubation (breathing tube), feeding tube, artificial nutrition and hydration, comfort care, and pain medication. But most people write vague things like "no heroic measures" or "natural death." Doctors don't know what that means. Does it mean no CPR but yes to feeding tube? Yes to pain medication even if it hastens death? The more specific you are, the better. Talk to your doctor about what each option means for your particular health situation.

Common scenarios help. "If I have advanced dementia and cannot recognize family, I do not want resuscitation or feeding tube. I want comfort care and pain management." "If I have terminal cancer with weeks to live, do not resuscitate. I want hospice and pain relief." "If I'm in a permanent vegetative state with no brain function, do not continue mechanical support." These are clear and actionable.

Your Healthcare Proxy Can't Read Your Mind—Tell Them Your Values

The healthcare proxy form names someone and gives them authority, but it doesn't tell them your wishes. You have to have the conversation. Sit down with your proxy and tell them: what makes life worth living to you? Are you afraid of suffering more than you're afraid of death? Do you have religious beliefs that affect your medical choices? Would you want to live in a nursing home if you can't care for yourself? These aren't easy conversations, but your proxy needs to know your values so they can make decisions aligned with what you'd want.

Hospitals Are Required to Ask, But Only If You Have Documents

Hospital intake forms ask about advance directives, but this is a conversation starter, not the law. Legally, hospitals are supposed to ask about your wishes and make them part of your medical record. But without a signed, witnessed, notarized advance directive, there's nothing legally binding. With one, you're on record with your hospital and doctor, and your wishes are in your medical file. In an emergency, they don't have to guess.

What to Do Right Now

Here is where to start, in priority order:

1. Get Your State's Official Advance Directive Form — Search your state health department website or your state bar association for advance directive or living will forms. Avoid generic internet templates; use your state's official form. Print it and read it carefully before filling anything out.
2. Fill Out the Healthcare Proxy Section First — Name the person (or people) you trust most to make medical decisions for you. This should be someone who knows your values, is willing to be contacted in a crisis, and won't be too emotionally overwhelmed to make clear decisions. Many people name their spouse; some name an adult child or trusted friend.
3. Fill Out the Living Will Section—Be Specific, Not Vague — State your wishes about resuscitation, feeding tubes, pain management, and end-of-life care. Don't just write "natural death." Write what that means for you. If you're unsure, talk to your doctor about your health situation and what these interventions would look like.
4. Have a Conversation With Your Healthcare Proxy — Sit down with the person you named and tell them your wishes, your values, and what makes life worth living to you. Ask them if they're willing and able to make these decisions. Make sure they understand they're empowered to decide, not just follow your every word—medical situations are complex and will arise that you didn't anticipate.
5. Sign, Have Witnessed, and Notarize (Per Your State's Rules) — Most states require two witnesses and a notary, or just two witnesses who are not doctors or related to you. Follow your state's exact requirements. Keep the original in a safe place, give a copy to your doctor and proxy, and tell your family where it is.

What Comes Next

Advance directives are about medical decision-making, but you also need financial power of attorney (who manages money if you can't) and a will (who gets your property after death). These are three different documents with three different purposes. An estate-planning lawyer can help you create all three—often bundled as "estate planning"—for $1,000 to $3,000.

If your life or health changes significantly, update your advance directive. If you're diagnosed with a serious disease, get clarification from your doctor about what interventions would actually do for you and update your living will. If you've broken up with your healthcare proxy, change them. Outdated directives are almost as useless as no directive.

Common Questions

Does my healthcare proxy get paid?

No, not unless you specifically arrange payment. Most proxies are family members or close friends who do it because they love you. Some hospitals or states offer small fees, but don't count on it. Make sure you're naming someone who's willing to take on the role.

Can I change my healthcare proxy later?

Yes, anytime. Create a new advance directive, sign and notarize it, and file it with your doctor. The new one supersedes the old one. Tell your old proxy and your new proxy what happened.

What if my healthcare proxy and my family disagree?

The healthcare proxy has legal authority to make decisions, not the family. But hospitals and doctors try to avoid conflicts. If there's serious disagreement, a hospital ethics committee may get involved, or a court order may be necessary. Having a clear living will helps prevent this.

Does naming a healthcare proxy mean I want to pull the plug on everything?

No. Naming a healthcare proxy just means someone can make decisions if you can't. What decisions they make depends on your living will and your values. You could be very pro-intervention or very pro-comfort-care; the proxy carries out what you want.

Can I be an organ donor even with advance directives?

Yes. You can state in your living will that you want to be an organ donor. You can also register separately on your state's donor registry. Having both is clearest. Your healthcare proxy and family should know your wishes.

What This Looks Like When It's Working

In a well-organized family, every adult has a signed, notarized advance directive on file with their doctor and a copy at home. The healthcare proxy knows they're named, knows the patient's values and wishes, and understands their role. If a medical emergency happens, doctors have written direction, the proxy can act with confidence and legal backing, and the family knows what the patient would have wanted. This prevents the scenario of kids fighting over whether to continue treatment while their parent is unconscious.

Families who've built this system keep advance directives and healthcare proxy information for each family member organized in a shared platform like Kinstone, with a note about which hospital has the original on file. In an emergency, the family can pull up who decides medical matters, what the patient's wishes are, and contact information for the proxy and the patient's doctor. This removes guesswork and conflict from a crisis moment.