End of Life and Advance Directive Documents

Living Wills, Proxies, and DNRs

Making sure your end-of-life wishes are carried out requires you develop written documentation. You'll need to consider documents like a living will, a durable power of attorney, and if you so choose, an order that will tell providers not to resuscitate you (called a DNR for "do not resuscitate".)

Do not resuscitate order form on clipboard entangled with stethoscope
Peter Dazeley / Getty Images

Legal requirements and the names for documents vary from state to state. Some require notarized signatures. Some require witnesses who are not family members to sign the documents.

Written documentation is a protection for you. The stricter the proof required that your documents are authentic, the better protected you are. Having signatures from people outside your family, including professionals, makes it much more difficult for someone to act outside your wishes.

Those requirements protect the loved one you designate as your proxy, too. With all the required signatures in place, the person who is assigned to carry out your wishes has a clear-cut set of rules to follow. The professionals involved will not be able to question your intent when the proof is in place.

Once you have answered the difficult questions that help you determine your end-of-life wishes, you'll be ready to fill out the paperwork required in the state or province you live in.​

If you live in more than one state, like those who live north in the summer and south in the winter, you will need to be sure the appropriate documents are written and signed for each location. Also, be sure to date the documents you develop so that if you decide to make changes later, your most current wishes will be enforced.

What Documents Record Advance Directives Decisions?

As mentioned, each state recognizes end-of-life documents differently. This is also true for the names assigned to those documents. The following are the titles heard most often, what they record, and what their intent is:

Healthcare Proxy

A proxy is both a document and a person.

Choosing someone to make medical decisions on your behalf means you have chosen that person as your proxy. It's always wise to choose a secondary proxy, too, because your primary proxy may predecease you, or may be unable to carry out your wishes for some other reason.

When a proxy is used to describe a document, it actually refers to a durable power of attorney (DPOA) which is a legal document, with signatures required, that describes the same information found in a living will (see below.) It may also be referred to as a medical power of attorney.

Living Will

When faced with a terminal illness, a patient can create a living will that will spell out her wishes as she faces the end of life. A living will answers questions such as whether the patient wants to be fed through a feeding tube (nutrition or hydration), whether breathing should be assisted by a machine (respirator), or whether the patient's heart should be started should he go into cardiac arrest. A living will is the document that helps the patient weigh the quantity of his life against what it will take to continue his life.

DNR

This is the acronym for a Do Not Resuscitate order. A DNR spells out the conditions under which you prefer not to be resuscitated by CPR (cardiopulmonary resuscitation) so that if your heart stops, you will not be revived.

Organ Donor Card

Many parts of the human body can be donated after death with the intent to improve the quality of life, and quantity of life for others. According to the U.S. Health and Human Services, each body can provide up to 50 donations of organs or tissues, including eyes, the heart, liver, stem cells, skin, and others.

For some of us, deciding to donate an organ or tissue is a simple decision. Others find the decision more difficult for a variety of reasons which may include religious beliefs.​

Each state has different laws about how your wish to donate may be recorded. For example, not all states recognize a signature on one's driver's license to be sufficient. You'll want to be sure to understand the requirements in your state.

General Resources to Help You With Advance Care Decision Documents

  • The American Hospital Association - Put It In Writing
  • Aging with Dignity - Five Wishes
  • National Hospice and Palliative Care Organization - Caring Connections 
  • U.S. Department of Health and Human Services - Organ Donor

Four Steps to Expressing Your End of Life Wishes

  1. Ask the right questions and determine your answers.
  2. Record those answers in the appropriate documents.
  3. Discuss your decisions and your wishes with your loved ones and others who need to know.
  4. File or store any paperwork or electronic files you have produced, and distribute copies to the right people.
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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. MedicareInteractive.org. Health care proxies.

  2. NOLO. How to write a living will.

  3. MedlinePlus. Do-not-resuscitate order. Updated February 18, 2018.

  4. Health Resources and Services Administration. What can be donated.

  5. Health Resources and Services Administration. Sign up to be an organ donor.

  6. The American Hospital Association. Put it in writing.

  7. Aging with Dignity. Five wishes.

  8. National Hospice and Palliative Care Organization. Patients and caregivers.

  9. U.S. Department of Health and Human Services. Organ donor.