Putting Your Wishes
in Writing
Living Will
The portion of your directive that specifies what treatments you do and do not want under various conditions — such as terminal illness, permanent unconsciousness, or advanced dementia. This is where your quality of life reflections become medical instructions.
Healthcare Proxy Designation
The portion that legally names the person who will make medical decisions on your behalf. Many states combine this with the living will into a single advance directive document.
CPR & Resuscitation
Do you want cardiopulmonary resuscitation if your heart stops? Under what conditions? If you are terminally ill, would you still want it attempted?
Mechanical Ventilation
Would you want to be placed on a breathing machine? For how long? Under what circumstances would you want it removed?
Artificial Nutrition & Hydration
If you could no longer eat or drink, would you want a feeding tube or IV fluids? Temporarily? Permanently? Under what conditions?
Pain Management
Do you want all available pain relief, even if it may shorten your life or affect your consciousness? Or do you prefer to remain as alert as possible?
Dialysis
If your kidneys fail, would you want dialysis? As a temporary measure during acute illness? As an ongoing treatment? Under what conditions would you want it stopped?
Organ & Tissue Donation
Do you wish to donate your organs or tissues after death? All organs, or specific ones? Do you want to donate your body to medical science? Document your wishes clearly.
Step 1: Obtain Your State’s Form
- Every state has its own advance directive form, available free from your state’s health department or bar association
- National resources like CaringInfo (NHPCO) provide state-specific forms at no cost
- You may also use the worksheets in My Dying Wishes to prepare your answers before completing the legal form
Step 2: Fill It Out Thoughtfully
- Use your quality of life reflections from Step 2 as your guide
- Be as specific as possible — vague language leads to vague care
- Include both what you want and what you do not want
- Address the treatment decisions listed above (CPR, ventilation, nutrition, pain, dialysis, donation)
Step 3: Sign, Witness, and Notarize
- Sign and date the document in the presence of witnesses as required by your state
- Most states require two adult witnesses who are not your proxy or beneficiaries
- Some states require notarization — check your state’s specific requirements
Step 4: Distribute Copies
- Give copies to your healthcare proxy and alternate proxy
- Provide a copy to your primary care physician and any specialists
- File a copy with your local hospital
- Give copies to close family members
- Keep the original in a safe but accessible location — not a safe deposit box
- Consider registering it with your state’s advance directive registry if available
Being Too Vague
“No heroic measures” means nothing in a medical setting. Specify exactly which treatments you want or do not want, and under what conditions.
Filling It Out Alone
Your directive should reflect conversations with your proxy, your family, and ideally your physician. A document no one has seen cannot guide anyone.
Completing It and Forgetting It
Review your directive at least every five years, and after any major health event, hospitalization, diagnosis, or life change such as divorce or the death of your proxy.
Hiding It
An advance directive locked in a safe deposit box is useless in an emergency. Your proxy, your doctor, and your hospital need copies before a crisis occurs.
Why This Matters
Study after study shows the same result: the vast majority of Americans say they want to die at home, in comfort, surrounded by people they love. And yet the majority die in institutions, connected to machines, often in pain, and frequently alone.
The gap between what people want and what they get is not caused by bad doctors or uncaring families. It is caused by silence. By the absence of a written plan. By the assumption that someone, somewhere, will just know what to do.
Your advance directive closes that gap. It is your voice, preserved in writing, for the moment when you can no longer use it. And it is the greatest gift you can give to the people who love you — because it frees them from the impossible burden of deciding for you without knowing what you would have chosen.
Advance Directives Need Not Be Daunting
The first time many people pick up an Advance Directive form, they freeze. "How can I possibly foresee all the situations that may occur to me?" The questions feel impossibly large: At what point would I decide life was no longer worth living? How will my values shape decisions I can't yet imagine?
Here is the reassuring truth: you don't have to foresee every circumstance. The California State Advance Directive, for example, reduces the core question of life-sustaining treatment to just two choices:
Choice (b) — To Prolong Life: I want my life prolonged as long as possible within accepted healthcare standards.
Neither answer is black and white, and you may modify your response as your situation changes. The real issue is trust: whom do you trust to make decisions for you when you cannot? You have the power to name that person.
The alternative — no decision — is itself a decision: it authorizes the most aggressive, expensive, life-sustaining treatment possible, regardless of your prognosis or your wishes. So relax. Talk it through with those you love. Get everyone on the same page.
Next Step: The Death Talk
Your directive is written. Your proxy is named. But none of it matters if the people in your life do not know about it. The next step is the conversation that ties everything together — telling your family, your proxy, and your physician what you have decided, and why.
Continue to Step 5 →