Advance Directives: Putting Your Wishes in Writing Before You Need To

Some of the most important decisions about your care may arrive at a moment when you cannot speak for yourself. An advance directive is simply a way of saying, ahead of time and in your own words, what you want to happen and who you trust to speak for you if you no longer can. It is one of the kindest, clearest gifts you can leave the people who love you, because it spares them from guessing.

Here is what advance directives are, the forms they take in New York, and how they fit alongside the other end-of-life choices you may be weighing.

What an advance directive actually is

An advance directive is a legal document that records your health care wishes for a time when you are unable to make or communicate decisions yourself, such as if you are unconscious, sedated, or living with an illness that has taken away your capacity to decide. It does not hand your autonomy to anyone else. It extends your voice forward into a moment you cannot be present for. Advance directives ensure that the care you receive still reflects what you would have chosen, even when you cannot say so in the room.

You do not need to be sick or elderly to have one. Any adult can complete an advance directive, and doing so early, while you are well, is often the calmest way to make these choices, with time to think and talk them through rather than in the middle of a crisis.

The health care proxy

In New York, the most important advance directive for most people is the health care proxy. This is a short document in which you name a person, your health care agent, whom you trust to make medical decisions on your behalf if a doctor determines you have lost the ability to make them yourself. It is worth choosing this person with care. They should be someone who knows you, who will honor your values even if they differ from their own, and who can stay steady and speak up in a difficult moment.

The strength of a health care proxy is its flexibility. No document can anticipate every medical situation, but a trusted agent can respond to the actual circumstances as they unfold, asking questions, weighing options, and always guided by what they know you would want. That is why appointing a proxy is often the single most valuable step you can take.

The living will

A living will works alongside the proxy. Rather than naming a person, it puts your specific wishes about treatment into writing: whether you would want to be kept on a ventilator, receive artificial nutrition and hydration, be resuscitated, or continue aggressive treatment if there were no reasonable hope of recovery. It speaks directly to your care team and to your agent, giving them clear guidance about the lines you do and do not want crossed. Where a proxy provides a trusted voice, a living will provides that voice with clear instructions to follow.

Medical Orders: DNR and MOLST

Some directives take the form of medical orders signed by your provider, which sit a step beyond the documents you complete on your own. A Do Not Resuscitate order, or DNR, instructs medical staff not to attempt CPR if your heart or breathing stops. A MOLST form, which stands for Medical Orders for Life-Sustaining Treatment, is a broader medical order that translates your wishes about resuscitation, intubation, and other interventions into instructions clinicians can act on immediately. These are typically used when you are already seriously ill, and they are created in conversation with your provider so that your care reflects your choices. In New York State, MOLST and DNR orders can be signed by physicians, nurse practitioners, and physician assistants.

How advance directives relate to medical aid in dying

As New York’s Medical Aid in Dying Act takes effect, it is important to understand where advance directives can and cannot reach. Advance directives govern whether treatments are given, continued, or withheld, and they can be carried out by your agent when you can no longer decide for yourself. Medical aid in dying is different. By law, a request for aid in dying must be made by you, in the moment, while you have the capacity to make it. It cannot be written into an advance directive, and your health care agent cannot request it on your behalf.

This is not a gap in the law but a deliberate protection. Aid in dying is reserved for a decision you make personally, with full capacity, so that the choice is unmistakably your own. Advance directives and aid in dying simply serve different purposes: one lets your wishes about treatment be honored when you cannot speak, and the other keeps one specific, profound decision firmly in your own hands.

Keeping your directives relevant, and available

A directive only helps if the right people can find it and rely on it. Once you have completed your documents, give copies to your health care agent, your close family, and your doctors, and keep your own copy somewhere accessible rather than locked away. It is also worth revisiting them from time to time, especially after a major life change such as a new diagnosis, a divorce, or the loss of the person you had named as your agent, to make sure they still reflect your wishes and the people you trust.

Bringing it together

Advance directives are, at heart, an act of care, both for yourself and for the people who will one day have to make decisions in your name. By writing down what you want and choosing who should speak for you, you keep your voice in the room even when you cannot be there, and you lift an enormous weight from those you love.

If you would like help thinking through a health care proxy, a living will, or how these choices fit with the other options now available in New York, that is exactly what we are here for. Please reach out. These are not easy things to plan for, and you do not have to navigate it alone.

This post was reviewed and verified by Daniel Cogan, NP