Advance Directive vs Living Will: What's the Difference and Which Do You Need?

An advance directive is the umbrella term for legal documents that state your health care wishes, or name someone to decide for you, if you can't speak for yourself. A living will is one type of advance directive. It lists which treatments you do or don't want if you are dying or permanently unconscious. The other main type, a health care power of attorney (also called a health care proxy or agent), names the person who makes medical decisions for you.

What is an advance directive?

An advance directive lets you tell family, friends and health care professionals what you want, so there is less confusion later. MedlinePlus describes the two main parts as a living will and a durable power of attorney for health care. Cornell Law School's definition adds that an advance directive takes effect only when illness or incapacity leaves you unable to make decisions.

These documents are about your medical care while you are alive. They are not the same as a will that says who gets your property, which is covered below.

What is a living will?

A living will is a written statement of the treatments you would and wouldn't want. MedlinePlus lists the usual topics: dialysis, breathing machines, CPR, tube feeding and organ or tissue donation. It applies if you are dying or permanently unconscious and can't decide for yourself, and the exact wording and triggers depend on your state's law and form.

Doctors and hospitals follow it as your own instruction. Cornell Law School notes that a provider who gives life-sustaining treatment against a living will they knew about could be sued for medical battery, but a claim is unlikely to succeed if the provider did not know the document existed. That is why sharing copies matters.

What is a health care power of attorney?

This document names someone, often called your agent, proxy or surrogate, to make health care decisions for you when you cannot. You choose the person, and you can name a backup.

Its main advantage is flexibility. A living will only covers what you thought to write down. An agent can decide about situations you didn't expect, using what they know about you. A health care power of attorney is separate from a financial power of attorney, and it generally ends at death. For what happens to a power of attorney after a death, see power of attorney and funeral arrangements.

Living will vs health care agent: how they differ

Do you need both?

Many people complete both, because the two documents cover each other's gaps. The living will records your wishes, and the agent interprets them and acts on them. Medicare describes an advance directive as containing both a health care proxy and a living will. Some states offer one combined form, so use your state's version rather than mixing forms from different places.

Talk to the person you choose before you name them. They should know your values and be willing to speak up with doctors. The guide on advance healthcare directives step by step goes through the choices in more detail.

How is an advance directive different from a DNR, a POLST and a last will?

• DNR order. A do-not-resuscitate order is a document telling providers not to do CPR if your heart or breathing stops, according to MedlinePlus. See DNR orders explained.
• POLST. A POLST is a portable medical order signed by a clinician. The National POLST Collaborative says it is intended for people who are seriously ill or have advanced frailty, and it travels with the patient between care settings. An advance directive is for everyone.
• Last will and testament. This covers your money and property after death. It has no power over your medical care. See does a will cover funeral arrangements for what a will can and can't do.

How much does an advance directive cost?

It can cost nothing. CaringInfo provides free advance directive forms and instructions for every state. Medicare Part B covers voluntary advance care planning conversations. You pay nothing if your provider accepts assignment and the conversation is part of your Welcome to Medicare or yearly Wellness visit. If it happens during other care, the Part B deductible and 20% coinsurance apply.

Medicare does not supply the forms. It suggests talking to an attorney or your health care provider for help. Lawyer fees and online service prices vary widely, so get a quote before you pay. If you are also preparing a will or trust, an attorney may be able to handle these documents together, but that is optional.

State rules: witnesses, notaries and moving

Each state has its own rules. CaringInfo says states differ on witnesses, notarization and other requirements, so read the form's instructions. The National Cancer Institute warns that a document valid in one state may not be accepted in another. If you split your time between states or move, complete a form for each state, or check with an attorney.

How to make an advance directive

1. Think about what matters to you. Consider what kind of care you would want if you were seriously ill, and what you would not.
2. Choose your agent and a backup. Ask them first.
3. Get your state's form. Start with CaringInfo's free state forms.
4. Sign it the way your state requires. That may mean two witnesses, a notary, or both.
5. Share copies. Give them to your agent, your family, your doctor and the hospital you use most. Keep the original where it can be found quickly, not only in a safe deposit box. MedlinePlus also suggests carrying a copy in your wallet.
6. Review it. You can change or cancel it at any time, and you should tell everyone who has a copy when you do. Many people review theirs after a diagnosis, a divorce, the death of their agent or a move.

How many people have one?

Fewer than half. A 2017 review in Health Affairs, covering 150 studies from 2011 to 2016 and nearly 800,000 people, found that about 37% of US adults had completed some kind of advance directive. Completion was comparable for chronically ill patients and healthy adults. Those figures are older, and recent rates may differ.

What happens if you don't have one?

Doctors usually turn to family members, and the order in which relatives are chosen varies by state. In disputed cases a court may become involved. The National Cancer Institute advises completing these documents while you are healthy instead of waiting for a serious diagnosis.

What to do next

1. Download your state's free form from CaringInfo and read the instructions.
2. Ask the person you want as your agent, and choose a backup.
3. Sign and witness the form as your state requires, then give copies to your agent, family and doctor.
4. If you are seriously ill, ask your clinician whether a POLST or DNR order is appropriate.
5. When you are ready, pair this with the rest of your plan in the end-of-life planning checklist.