The living will / advance directive

What it does

An advance directive — often called a living will — records your instructions about life-sustaining treatment for the situation where you cannot make or communicate decisions and your condition is terminal, permanently unconscious or end-stage. It speaks directly to your physicians, so it works even when your family disagrees.

It never applies while you can still speak for yourself. As long as you have capacity, your own contemporaneous decision controls, whatever the document says.

The choices you are making

• CPR, mechanical ventilation and dialysis: the interventions that restart or replace a failing organ system.
• Artificial nutrition and hydration: a separate decision in most states, and one many people answer differently from ventilation.
• Antibiotics and blood products: treatment that may extend life without restoring function.
• Comfort care: pain relief, hygiene and dignity, which should continue in every case even when other treatment stops.
• Anatomical gifts: whether your organs and tissue may be used for transplant, therapy, research or education.

State variations that actually change the document

Some states publish a statutory form and expect the document to track its language. Roughly half restrict the withdrawal of life support while you are pregnant, so your directive has to address pregnancy expressly. Several require two physicians rather than one to certify the qualifying condition, and a handful treat mental-health treatment as a separate declaration that only counts if you sign it as such.

Witness and notary requirements differ too: most states want two adult witnesses who are not your relatives, heirs, agents or paid caregivers, and some accept a notary acknowledgment in place of witnesses. Your state's page in this knowledge base lists the rule that applies to you.

After you sign

Give copies to your healthcare agent, your primary physician and the hospital or facility likely to treat you, and keep the original where your agent can reach it quickly. A copy has the same effect as the original, and you can revoke the directive at any time in any way that communicates your intent — no formality is required to change your mind.