What is an advance healthcare directive (AHCD)?

An advance healthcare directive, or AHCD, is a legal document that has two functions:

• To express your healthcare wishes regarding medication, treatment options, and more
• To choose someone to make treatment decisions for you if you’re someday unable to communicate your wishes — for example, because of a degenerative illness or an incapacitating accident

In estate planning, an AHCD allows you to plan ahead. You can make decisions for the "future you" by having a say in the type of healthcare you may need someday. Not only does this help ensure you receive the care you want, but it also protects your loved ones from having to guess your wishes.

What are the parts of an AHCD?

An advance healthcare directive is a hybrid document consisting of two parts: a living will and a durable medical power of attorney.

Part 1: Living will

A living will is a legal document that lets you outline your preferences for medical care if you’re ever unable to communicate them yourself. If you have a living will, your doctors will generally try their best to follow any reasonable instructions in it. Among other things, your living will lets you:

• Identify medical treatments and procedures you don’t want to receive. For example, you could specify that you don’t want to receive a feeding tube or be placed on a ventilator.
• Describe the type of palliative care (or “comfort care”) that you’d like to receive. Palliative care is treatment that focuses on the patient’s quality of life in their final days, rather than trying to extend their life.
• Name your preferred hospital, and the doctor you’d like to supervise your care.

In some states, living wills are also called “medical directives” or “personal directives.”

Despite its name, a living will is different from a last will and testament. A living will is used while you’re alive to explain what kinds of healthcare procedures and medications you want. A will is used after you die to distribute your property. Learn more about the difference between these two important estate planning documents.

Part 2: Durable medical power of attorney

A durable medical power of attorney (POA) lets you give someone you trust the legal authority to make important decisions about your medical care in the event you’re unable to. This person is typically called your healthcare agent, proxy, or representative. Depending on where you live, a medical POA may also be called a “durable healthcare power of attorney” or “durable power of attorney for healthcare.”

Legally, your healthcare agent must act in your best interests. First and foremost, they must follow the wishes you outlined in your living will. If a situation arises that you haven’t addressed in your living will, then your healthcare agent can make those medical decisions on your behalf.

Who should you pick as your healthcare agent?

When choosing a healthcare agent, many people name a close friend or family member. It’s a good idea to choose someone who:

• Is competent and trustworthy
• Knows your preferences and values
• Has your best interests at heart

Why should you make an AHCD?

There are many reasons why it’s a good idea to create an advance healthcare directive. Here are a few:

• To provide you peace of mind that, no matter what happens, your healthcare wishes will be known and followed
• To prevent your loved ones from having to guess what healthcare treatment you want to receive
• To prepare for a major medical procedure, like a surgery, when you’ll be under anesthesia and unable to give consent
• To reflect any religious, spiritual, or philosophical beliefs you have that may impact what kind of healthcare you want to receive
• To prepare for the future if you have an ongoing or serious health problem, or in response to being diagnosed with a degenerative disease like dementia

How to make an advance healthcare directive

To make an advance healthcare directive, you need to first get the living will and durable medical POA forms specific to your state. Most states provide these forms for free (but you have to figure out how to fill them out on your own). Then, you’ll need to have your documents witnessed, notarized, or both, depending on which state you live in.

Another option is to use online software, like FreeWill, to create your AHCD for free. Our questionnaire takes you through each step of the process. After you’ve finished, you receive a document reflecting your wishes, along with instructions for how to execute it to make it valid in the state where you live.

You don’t need to hire an estate attorney to draft your advance healthcare directive. But if you have questions, consider meeting with one to make sure your AHCD reflects your wishes.

Whichever option you choose, give yourself time to make these decisions. Consider discussing them with your loved ones so they understand your wishes.

Once you've executed your advance healthcare directive, you should store it in a safe place and keep it up to date. Experts recommend updating your estate planning documents every three to five years. You should also revisit your document any time you have a major life change.

What happens if you don’t make an advance healthcare directive?

If you become incapacitated and don't have an AHCD, state law will likely determine what care you receive. These laws usually require your doctors to consult with your next of kin (like your spouse or immediate family members) about treatment.

This can put your loved ones in an uncomfortable position. They might not know what treatments you do or don't want. Family members may also disagree and end up arguing about care or treatment options, adding stress to an already difficult time.

What should you do after you execute your AHCD?

Once you create and execute your advance healthcare directive:

• Store your documents in a safe place, and tell your loved ones where to find them.
• Give copies to your healthcare agent, your primary care provider, and any other person (like your spouse) that may be asked about your healthcare.
• Talk through your preferences with your doctors and your loved ones to make sure they understand your wishes.

Having an AHCD helps you plan for the unexpected

Thinking about the possibility of being sick or gravely injured can feel uncomfortable. But planning for an unknowable future is actually the kindest thing you can do for your loved ones. By making these difficult decisions now, you provide a roadmap for future healthcare decisions that can give your loved ones peace of mind. And you make sure your preferences are taken into account, even if you’re unable to communicate.

Get started creating your advance healthcare directive today.