Advance Healthcare Directive vs. Living Will vs. Medical Power of Attorney
Three names for overlapping documents. Here is what each does, how they fit together, and what none of them covers.
By naveen · Updated · How we research our guides
What to know
- An advance directive gives instructions for medical care and applies only if your parent can't communicate their own wishes, according to the National Institute on Aging (NIA).
- The living will records the wishes; the medical power of attorney (or health care proxy) names the person.
- A directive is not a DNR: a DNR or POLST is a medical order that goes in the medical record.
- Without a directive, state law decides who can make medical decisions, according to NIA.
- Retirement Checklist puts the directive in order with the power of attorney and HIPAA authorization.
An advance healthcare directive is the umbrella term for legal documents giving instructions for medical care if your parent can't communicate; NIA names the two most common: the living will and the durable power of attorney for health care. The living will is the wishes half. The medical power of attorney is the naming half.
Some states put both halves in one form. California's Advance Health Care Directive covers treatment wishes, and the state's court self-help site says "It also lets you appoint an agent to communicate your wishes." Texas uses separate forms: a Directive to Physicians and a Medical Power of Attorney.
Why are there so many names for the same thing?
Each state writes its own forms and picks its own names. New York calls the naming document a Health Care Proxy, Texas a Medical Power of Attorney, and California an Advance Health Care Directive. NIA notes that the person named, the proxy, is "also known as a representative, surrogate, or agent."
What stays the same is the pair of questions: who decides, and what did they want. NIA treats the two as separate choices: "A proxy can be chosen in addition to or instead of a living will."
| Document | What it does | Who holds it |
|---|---|---|
| Advance directive | Umbrella term for the documents below; some states combine them in one form | Copies go to the proxy, doctors and loved ones (NIA) |
| Medical power of attorney / healthcare proxy | Names who makes medical decisions if your parent can't communicate | Copies go to the proxy, doctors and loved ones (NIA) |
| Living will | Records which treatments your parent would want or avoid, and when | Copies go to the proxy, doctors and loved ones (NIA) |
| DNR / POLST | A medical order put in place with a doctor | The medical chart (NIA) |
Who makes medical decisions if your parent can't?
The person named in the medical power of attorney does. NIA calls that person the health care proxy, someone "who can make health care decisions for you if you are unable to communicate these yourself."
Without one, state law decides. NIA says the decision-maker "is typically your spouse, your parents if they are available, or your children if they are adults," and that an unmarried partner who wasn't named could be left out. Florida's list, for example, runs from a court-appointed guardian to the spouse, then "a majority of the adult children who are reasonably available for consultation," then parents, siblings, other relatives and a close friend (Fla. Stat. 765.401).
What does a living will record?
A living will records which medical treatments your parent would want, which they would avoid, and under which conditions each choice applies (NIA). NIA's living will guide walks through CPR, ventilators, pacemakers and implanted defibrillators, and artificial nutrition and hydration, including feeding tubes.
The form is only part of it. NIA says "Having meaningful conversations with your loved ones is the most important part of advance care planning," and notes that an advance directive "is legally recognized but not legally binding." Its advice: "Talking with your loved ones ahead of time may help them better navigate unanticipated issues."
Does a healthcare directive cover money?
No. A healthcare directive covers medical care. NIA lists the durable power of attorney for finances as its own document, one that "names someone who will make financial decisions for you when you are unable to." New York's Attorney General says the state's form "does not give your agent the power to make non-health care decisions for you, such as financial decisions." That takes a separate durable financial power of attorney.
It can help to sign both at the same appointment, and to check that both exist rather than assume one covers the other.
Is an advance directive the same as a DNR?
No. A DNR is a medical order that NIA says "becomes part of your medical chart" and tells hospital or nursing facility staff not to attempt CPR. An advance directive is a planning document. NIA notes that "Even though a living will might state that CPR is not wanted, it is helpful to have a DNR order as part of your medical file," and that "Without a DNR order, medical staff will attempt every effort to restore your breathing and the normal rhythm of your heart."
Outside the hospital, an out-of-hospital DNR order alerts emergency medical personnel, and POLST or MOLST forms are medical orders "that health care professionals can act on immediately in an emergency" (NIA). If that distinction matters to your parents, it is a conversation for their physician, not a form to download.
What varies by state?
The forms, the witness and notary rules, and whether an out-of-state document is honored. Some examples from state sources:
- Witnesses and notary. California's form "must be signed by two qualified witnesses or acknowledged before a notary public." Texas's Medical Power of Attorney can be notarized or signed before two adult witnesses, and its list of people who "May Not Act As One Of The Witnesses" includes the agent, relatives, heirs, the attending physician and some health care facility staff. New York's Department of Health says its proxy needs no lawyer or notary, "just two adult witnesses," and the agent cannot be one.
- Free forms. NIA says "Many states have their own forms that you can access and complete for free." California's Attorney General, Texas Health and Human Services and New York's Department of Health each publish one.
- Out-of-state documents. Florida treats a directive signed in another state "in compliance with the law of that state or of this state" as validly executed (Fla. Stat. 765.112).
- The default decision-maker order that applies when nothing was signed, as in Florida's list above.
State-by-state, from each state's own statutes: California, Texas, Florida, New York, Ohio, Georgia, North Carolina, Illinois, Michigan, Indiana, Arizona, Washington, Colorado, Wisconsin, Connecticut, Pennsylvania, Louisiana, Massachusetts, Oklahoma, Oregon, Kansas, Missouri, New Mexico, Utah, Alabama, Arkansas, New Jersey, Kentucky, Minnesota, Mississippi, South Carolina, Virginia, Maryland, Montana, Hawaii, Nebraska, Alaska, Nevada, Tennessee, Delaware, Iowa, Idaho, Rhode Island, Maine, South Dakota, D.C., New Hampshire, West Virginia, North Dakota, Vermont, Wyoming.
What questions are worth asking?
- Who would your parent want speaking for them? It need not be the eldest, the nearest, or the one who'd be most upset to be passed over.
- Does that person know they've been named, and have they agreed? NIA suggests discussing values and preferences with the proxy once your parent has chosen.
- Is there a named alternate if the first person is unreachable or too close to it to decide?
- Where will the copies live, and can the agent get one at 2am?
- Does the primary care practice have it on file, and does the hospital your parents would be taken to?
- Has anything changed (a divorce, a death, a move, a diagnosis) since it was signed? NIA suggests reviewing directives at least once a year and after a major life event.
Frequently asked questions
Is an advance directive the same as a living will?
Not quite. An advance directive is the umbrella term; NIA names the living will and the durable power of attorney for health care as the two most common types. The living will records what treatment someone would or wouldn't want. Some state forms, such as California's, combine both in one document, which is why the terms get blurred.
Do we need a lawyer for an advance healthcare directive?
Not necessarily. NIA says "A lawyer can help but is not required to create your advance directives," and that many states publish free forms. Witnessing or notarization rules still apply and differ by state. For a financial power of attorney, the CFPB says working with a lawyer "could help protect you against potential abuses."
Does a healthcare directive let me manage my parent's money?
No. It covers medical decisions only. Authority over money comes from a separate document, a durable power of attorney for finances, which NIA lists on its own. New York's Attorney General says the state's health care proxy form "does not give your agent the power to make non-health care decisions for you, such as financial decisions."
Is a directive signed in one state valid in another?
It depends on the state where care happens. Florida, for example, accepts a directive signed elsewhere if it complied with that state's law or Florida's (Fla. Stat. 765.112). NIA suggests that people who spend a lot of time in more than one state consider preparing directives on each state's form. An elder law attorney in the relevant state can confirm.
What happens if there is no advance directive?
State law decides who can make medical decisions. NIA says this "is typically your spouse, your parents if they are available, or your children if they are adults," and that an unmarried partner who wasn't named could be excluded. Without a living will, there is also no written record of what your parent would have wanted.
Where should the document live?
Somewhere the agent can reach it quickly. NIA says to give copies to the health care proxy, health care providers and lawyer, and notes that some states have registries that store directives for providers. NIA's planning checklist adds: "If your papers are in a bank safe deposit box, keep copies in a file at home."
What is a healthcare proxy?
The person named to make medical decisions for your parent if they can't communicate them. NIA says a proxy is "also known as a representative, surrogate, or agent," and the document that names one is a durable power of attorney for health care. In New York, the document itself is called a Health Care Proxy.
Which documents are types of advance directive?
NIA names the living will, which records treatment wishes, and the durable power of attorney for health care, which names a proxy, as the two most common. Some states combine them in one form. A DNR or POLST is a separate medical order that serves "in addition to your advance directive," in NIA's words.
Getting started
Every family's order is different. The plan this site builds asks four questions, including which state your parents live in, and puts the handful of steps that matter most for your family in order. It's free and takes about 90 seconds.
Related guides
Sources
- National Institute on Aging, Advance Care Planning: Advance Directives for Health Care: Living wills, health care proxies, DNR and POLST orders, free state forms, and what happens without a directive.
- National Institute on Aging, Preparing a Living Will: The treatments a living will can address.
- National Institute on Aging, Getting Your Affairs in Order Checklist: The financial power of attorney as a separate document, and where to keep copies.
- Consumer Financial Protection Bureau, What is a power of attorney (POA)?: Why a lawyer can help with a financial power of attorney.
- California Attorney General, Advance Health Care Directive form: California's statutory form and its witness or notary requirement.
- California Courts Self-Help Guide, Wills, estates, and advance care planning: What California's Advance Health Care Directive covers.
- Texas Health and Human Services, Advance directives forms: Texas's separate Directive to Physicians and Medical Power of Attorney forms.
- Texas Health and Human Services, Medical Power of Attorney form: Notary or witness options, and who may not act as one of the witnesses.
- New York State Attorney General, Health Care Proxy: What a New York health care proxy covers.
- New York State Department of Health, Health Care Proxy form: New York's witness rules.
- Florida Statutes §765.401, The proxy: Florida's order of decision-makers when no directive exists.
- Florida Statutes §765.112, Recognition of advance directive executed in another state: When Florida honors a directive signed elsewhere.
More on what this tool does and doesn't do, or browse everything we've written.