Health Care Proxy, Living Will, POLST: A Plain-English Guide to Advance Directives

Most people will face a time when they cannot make or communicate their own medical decisions, whether because of an accident, surgery, a sudden illness or a long decline. Advance directives are the legal documents that tell doctors and family what you want in that situation, and who should decide for you.

They are not just for older adults or people who are very sick. Any adult can make them, and in many states you can do it for free without a lawyer. Here is how the pieces fit together.

"Advance directive" is an umbrella term. The two main documents are:

• A health care proxy (also called a medical or health care power of attorney), which names a person to make decisions for you.
• A living will, which records the kinds of treatment you would or would not want.

Many states combine both into one form, often called an advance health care directive. The rules and names differ by state, so it is important to use your own state’s form or one that meets its requirements.

These documents only come into play when you cannot make or communicate decisions yourself. As long as you can, you speak for yourself, and you can change your mind at any time.

Health care proxy: the person who speaks for you

A health care proxy lets you name a health care agent to make medical decisions on your behalf if you cannot. Your agent can talk with doctors, review options, and accept or refuse treatments based on what you would want.

According to MedlinePlus, a health care power of attorney covers medical decisions only. It does not give the person authority over your money or legal affairs. That requires a separate financial power of attorney.

Naming an agent matters even if you are close to your family. Without one, decisions may fall to relatives under your state’s default rules, which may not match who you would have picked, and disagreements can delay care.

Living will: your wishes in writing

A living will describes the medical treatments you would want or not want, especially near the end of life or if you are permanently unconscious. It may cover:

• CPR if your heart or breathing stops
• Breathing machines (mechanical ventilation)
• Feeding tubes and IV fluids
• Dialysis
• Comfort care, such as pain relief, even if it does not extend life
• Organ and tissue donation

No document can predict every situation, which is why a living will works best alongside an agent who knows your values and can apply them to decisions no one saw coming.

POLST and DNR: medical orders for serious illness

A POLST form is different from an advance directive. It is a medical order filled out with your health care provider that records the treatments you want in a medical emergency, such as whether you want CPR or a breathing tube. According to POLST, it is meant for people who are seriously ill or frail, and it is optional.

The form travels with you so emergency responders and hospitals can follow it. States use different names, such as MOLST, POST or MOST. A healthy adult usually does not need one; an advance directive is the right starting point.

A do-not-resuscitate (DNR) order is a doctor’s order not to perform CPR if your breathing or heartbeat stops. Your provider writes it after talking with you or your agent.

HIPAA authorization: letting people get information

Federal privacy law (HIPAA) limits who can receive your health information. According to HHS, a person who can make health care decisions for you under a health care power of attorney is generally treated as your personal representative and can access your records, within the scope of that authority.

But many health care powers of attorney only take effect once you can no longer decide for yourself. A separate HIPAA authorization form lets you name people, such as a spouse, adult child or close friend, who can talk with your doctors and get information about your care now, even while you are making your own decisions. Ask your doctor’s office or hospital for their authorization form, or include one with your other planning documents.

How to choose your agent

Choose someone who can follow your wishes, not their own. Good questions to ask yourself:

• Will this person respect my values even if they disagree?
• Can they stay calm and make hard decisions under pressure?
• Will they speak up to doctors and family if needed?
• Are they usually reachable, and do they live close enough to be there if needed?
• Are they willing to take on the role?

Many people also name a backup agent in case the first choice is not available. States have rules about who can serve as an agent, and many limit whether your own doctor or the staff caring for you can take the role, so check the instructions on your state’s form.

Then talk with your agent. Explain what matters most to you, such as being at home, avoiding pain, living as long as possible, or not being kept alive on machines if recovery is unlikely. The conversation is as important as the paperwork.

Getting your state’s forms

Advance directive laws are state-specific, including who must witness your signature and whether a notary is required. Places to get forms:

• CaringInfo, a program of the National Alliance for Care at Home, offers free advance directive forms and instructions for each state.
• Your state health department or attorney general’s website often posts official forms.
• Your doctor’s office or hospital, which may have forms and staff to help.
• Your local Area Agency on Aging, which you can find through the Eldercare Locator at 1-800-677-1116.
• An elder law or estate planning attorney, if your situation is complicated or you want legal advice.

Read the instructions carefully and follow your state’s signing and witness rules, or the document may not be valid. If you split time between states, ask whether your forms will be honored in both.

Where to keep copies, and when to update

A directive only helps if people can find it.

• Keep the original somewhere safe but easy to reach. Avoid a safe deposit box that others cannot open.
• Give copies to your agent, backup agent, doctors and close family.
• Ask your doctor and hospital to add it to your medical record.
• Bring a copy when you go to the hospital, and keep a photo or scan on your phone.
• Keep a list of who has copies, so you can replace them all if you make changes.

Review your documents every few years and after major life events, such as:

• A new diagnosis or a big change in your health
• Marriage, divorce or the death of your agent
• A move to another state
• A change in how you feel about certain treatments

If you update your documents, share the new version and ask people to destroy the old ones.

The bottom line

An advance directive is a gift to the people who love you: it tells them who should decide and what you would want. Name a health care agent and a backup, write down your wishes in a living will, and consider a HIPAA authorization so family can get information. If you are seriously ill or frail, ask your clinician about POLST. Use your state’s forms, follow its signing rules, share copies widely and review them as your life changes.

This article is general information, not medical or legal advice. For questions about your situation, talk with your health care provider or an attorney in your state, and call 911 in an emergency.