What is an advance directive? What to put in yours
The short answer
An advance directive is a legal document that tells doctors what medical care you want if you can't speak for yourself. It usually has two parts. A living will records your treatment wishes, and a medical power of attorney names someone to decide for you. Most adults benefit from both.
An advance directive is the part of your plan that speaks for you at the hospital. It covers the moments when you can't answer the doctor's questions yourself: after a stroke, a bad fall, or during a serious illness.
It sounds heavy, but the work is gentle: think about what matters, write it down, share copies. This page explains what goes in one, how to sign it so it counts, and where it fits among your other estate planning documents.
What is an advance directive?
An advance directive is a written set of instructions for your medical care. It only comes into play if you can't communicate your own wishes.
The National Institute on Aging describes two common kinds. A living will says which treatments you would want or avoid, and under which conditions. A durable power of attorney for health care names a person to make decisions for you (National Institute on Aging).
Medicare.gov describes an advance directive the same way, as two parts: a health care proxy and a living will (Medicare.gov). The names vary by state.
| Part | What it does | Who it involves |
|---|---|---|
| Living will (Washington: health care directive) | Records your wishes about life-sustaining treatment | Your doctors, who read it |
| Medical power of attorney | Names someone to make health care decisions when you can't | The person you name as your health care agent |
Our post on health care power of attorney vs living will goes deeper on why the two work best as a pair.
Washington's version: the health care directive
Washington calls its living will a "health care directive," under the Natural Death Act. Any adult may sign one about withholding or withdrawing life-sustaining treatment in a terminal condition or a permanent unconscious condition (RCW 70.122.030).
Those two situations are defined narrowly. A terminal condition is incurable and irreversible and will cause death within a reasonable time. A permanent unconscious condition means no reasonable chance of recovery from an irreversible coma or persistent vegetative state (RCW 70.122.020).
Washington's legal definition of life-sustaining treatment leaves out medicine and procedures given only to relieve pain (RCW 70.122.020). Choosing to decline life support is not the same as declining comfort.
The statutory form asks you to check whether you want artificially provided nutrition and hydration in those conditions. It also says you may add other specific directions (RCW 70.122.030). That space is where your own words go.
Why the medical power of attorney matters so much
Most hard medical moments are not terminal or permanent: a stroke with a chance of recovery, or a surgery decision during a confusing week.
A living will may say nothing about those situations. A medical power of attorney covers them. It names a person who can weigh what is happening and decide as you would. In Washington, that authority has to be expressly granted in a power of attorney (RCW 11.125.240).
What should I put in my advance directive?
Here is a checklist. You don't need to settle every item in one sitting, and a cup of tea helps.
The person who decides
- Your health care agent, by full name, with phone number and city.
- A backup agent, in case your first choice can't be reached.
- Whether your agent can see your medical records. In Washington, an agent with general health care authority can (RCW 11.125.400).
Your treatment wishes
- CPR if your heart or breathing stops.
- A breathing machine (ventilator).
- Tube feeding and IV fluids. Washington's form asks about this directly.
- Dialysis if your kidneys fail.
- Antibiotics in a final illness.
- Comfort care and pain relief, even if it makes you sleepy.
- Whether you would want to try a treatment for a set time, then stop if it isn't working.
What matters most to you
- What a good day looks like. Reading the paper, the dog's afternoon walk, recognizing your friends.
- What you would find unacceptable for the long term.
- Where you would prefer to be cared for at the end, if you have a preference: home, hospice, a hospital.
- Spiritual or cultural wishes, and anyone you'd like called.
Other wishes
- Organ and tissue donation. Medicare.gov notes that a living will can state this (Medicare.gov).
- Mental health treatment, if relevant. Washington has a separate mental health advance directive for that (RCW 71.32.020).
The "what matters most" section is often the most useful one. Your agent will face situations no form predicted, and your values help them decide. If you'd like a guide to writing those wishes in everyday words, see our post on writing down your treatment preferences.
How do I make it legally valid?
Signing rules vary by state, so the document should be drafted for where you live. Here is Washington, as a worked example.
| Document | Washington signing rule | Witness limits |
|---|---|---|
| Health care directive | Notarized, or signed before two witnesses (RCW 70.122.030) | Not a relative by blood or marriage, not an heir, not your attending physician or their employee, not an employee of a health facility where you are a patient |
| Medical power of attorney | Signed and dated, then notarized or witnessed by two people (RCW 11.125.050) | Not related to you or your agent, not your home care provider, not a care provider where you live |
You don't always need a lawyer. The National Institute on Aging says a lawyer can help but is not required (National Institute on Aging). What matters is that the document meets your state's rules.
Washington honors a directive signed in another state to the extent its own law allows (RCW 70.122.030).
Where should I keep it, and who gets a copy?
A directive in a locked drawer can't help anyone. Give copies to your health care agent, your backup, your doctor, and anyone who might be called first.
In Washington, the directive or a copy is meant to become part of your medical record (RCW 70.122.030). Federal rules also require hospitals and nursing facilities that take Medicare to ask. They must give adult patients written information on advance directives and note in the record whether you have one (42 CFR 489.102).
Those same rules say a facility can't make your care depend on whether you have a directive (42 CFR 489.102).
Keep the original somewhere your agent can reach at short notice, such as with your other important papers. Our post on the care plan covers keeping this information together.
Can I change it later?
Yes. In Washington, you can revoke a directive at any time by destroying it, signing a written revocation, or saying so out loud. A written or spoken revocation takes effect once your attending physician is told (RCW 70.122.040).
The National Institute on Aging suggests reviewing your directives at least once a year. It also suggests a review after big changes such as retirement, a move or a new diagnosis (National Institute on Aging).
What happens if I don't have one?
State law picks someone for you. In Washington, a court-appointed guardian comes first, then your agent under a durable power of attorney for health care. Then come a spouse or registered domestic partner, adult children, parents and adult siblings (RCW 7.70.065).
A close friend can consent only at the very end of that list, with a sworn declaration (RCW 7.70.065). Our post on medical decisions without a power of attorney walks through that list.
Naming an agent puts the person you trust at the front of the line. If the obvious person lives far away or is your own age, a professional can stand behind them as backup. Kinly's membership, for example, includes a medical power of attorney written for your state, with a trust company that can be named first or as backup.
An advance directive is not a POLST
As illness becomes serious, some people also sign a POLST, a medical order form completed with a clinician. The Washington State Medical Association says a POLST complements an advance directive and does not replace it (WSMA).
Our post on POLST vs advance directive vs DNR explains who each one is for. And when you're ready to put the documents in place, how to get power of attorney covers the practical steps.
Common questions
Is an advance directive the same as a living will?
Not quite. A living will is one kind of advance directive, the part that records your treatment wishes. An advance directive can also include a medical power of attorney, which names a person to decide for you. In Washington, the living will is called a health care directive.
Do doctors have to follow my advance directive?
Usually they will, but there are limits. The National Institute on Aging says an advance directive is legally recognized but not legally binding in every situation. In Washington, a doctor or facility that can't honor your directive must tell you. If you stay, a written plan is prepared (RCW 70.122.060).
Does an advance directive stop pain medicine?
No. Washington's definition of life-sustaining treatment excludes medication and procedures given only to relieve pain. You can decline life support and still ask for full comfort care.
Do I need a lawyer to make an advance directive?
Not necessarily. Many states publish free forms. What matters is that you sign it under your state's rules, which in Washington means a notary or two qualified witnesses.
How often should I update my advance directive?
The National Institute on Aging suggests reviewing it at least once a year. Review it again after a move, retirement or new diagnosis. Give the updated copy to your agent and your doctor.
Sources
- Advance Care Planning: Advance Directives for Health Care (National Institute on Aging)
- Advance care planning (Medicare.gov)
- RCW 70.122.020: Natural Death Act definitions (Washington State Legislature)
- RCW 70.122.030: Health care directive (Washington State Legislature)
- RCW 70.122.040: Revocation of directive (Washington State Legislature)
- RCW 70.122.060: Procedures by physician (Washington State Legislature)
- RCW 71.32.020: Mental health advance directives, definitions (Washington State Legislature)
- RCW 11.125.050: Power of attorney, requirements (Washington State Legislature)
- RCW 11.125.240: Authority that must be expressly granted (Washington State Legislature)
- RCW 11.125.400: Agent authority, health care (Washington State Legislature)
- RCW 7.70.065: Persons authorized to consent for patients without capacity (Washington State Legislature)
- 42 CFR 489.102: Advance directive requirements for providers (Legal Information Institute)
- POLST (Washington State Medical Association)
This page is general information, not legal or financial advice. Laws vary by state.