Healthcare directive
Write down the care you would and would not want if you cannot speak for yourself.
Set out your healthcare wishes and who can speak for you.
- Personal / Legal document
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Key features
Who may speak for you
Blanks for the person who may speak for you and an alternate, and for any separate health-care agent document, with its date.
What matters most
A section for what the people deciding should weigh most heavily, in your own words.
Particular treatments
A list asking what you want about restarting the heart, a breathing machine, tube feeding, dialysis, antibiotics and transfusion, with a line for others.
Comfort, place of care and faith
Your wishes on pain relief, where you would want to be cared for, and faith and observances.
Donation, people to tell and copies
Wishes on donation and research, who to tell, and who holds copies, including your doctor.
About this document
A health-care directive records your wishes about medical treatment in case you cannot make or explain your own decisions: who may speak for you, what matters most to you, and what you want about specific treatments near the end of life.
This blank form is written for you to complete by hand in your own words. States differ on how a directive must be signed, witnessed and notarized, on what it can cover and on whether a state form is required, and some medical orders are made on a separate clinician form. Check your state's rules, or ask a lawyer, before relying on it.
Is this document right for you?
Useful when
- You want your wishes about treatment recorded before a crisis
- You have strong views about specific treatments
- You want family to be spared guessing
Commonly used by
- Adults planning ahead
- People with a serious or progressive illness
- Older adults updating their paperwork
Not sure? about your situation first.
Alternatives
These are separate documents, for different jobs.
- Living willRecord your wishes about medical treatment in advance.View document
- Medical power of attorneyName someone to make medical decisions if you can't.View document
- End-of-life planWrite down your wishes for your final arrangements.View document
- Personal care profileShare your routines and care preferences with those caring for you.View document
When to use this
- After a diagnosis, to record what treatment you would want
- When you want your family to know your preferences before an operation
- When you are updating an older directive
What happens next
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More in Health Care Planning
- Living willRecord your wishes about medical treatment in advance.View document
- Medical records releaseAllow a named person to receive your medical records.View document
- Personal care profileShare your routines and care preferences with those caring for you.View document
- End-of-life planWrite down your wishes for your final arrangements.View document
Ready when you are.
Questions
About the healthcare directive
They overlap. This form combines a statement of wishes with who may speak for you. The living will on this site is a separate document with its own builder.
Still have a question? .