A Guide to Advance Medical Directives and Medical Orders
When you or a loved one receives a serious medical diagnosis, whether sudden or long anticipated, it can bring a wave of uncertainty that touches every part of life. It is natural to want as much information as possible so that you can get a sense of direction. What can you expect moving forward? What treatments may be involved? What are the next steps? Some answers may come quickly, while others will take time to unfold.
As you begin to process this change and coordinate care with your medical team, it is also an important time to pause and make sure you have the right documents in place to clearly communicate and protect your wishes. Some of these are legal documents known as advance medical directives and some are medical orders signed by a physician that complement a health care proxy and living will.
What are advance medical directives?
Advance medical directives, often simply referred to as advance directives, are legal documents that outline your preferences for medical care if you are unable to communicate your wishes. They are one part of a comprehensive estate plan. Any adult age 18 or older should consider having these documents in place, as medical emergencies can happen at any time. A health care proxy and a living will are advance directives.
What are medical orders?
Medical orders are issued by healthcare professionals to provide specific instructions or directives regarding patient care.
Together, these documents help prevent confusion during critical moments and ease the burden on family members by removing uncertainty about the type of care you would or would not want to receive. They also allow healthcare providers to act more quickly and confidently, knowing they are following your wishes.
1. Health Care Proxy
A health care proxy is a legal document that appoints someone to make medical decisions on your behalf if you are unable to communicate or make decisions. You determine how much control you want your health care proxy to have over your medical decisions. You may grant them broad or limited decision-making power and you can include specific instructions or preferences, such as involving other family members in certain decisions. Depending on the state, a proxy’s responsibilities may include making decisions about treatments and providers, accessing medical information, and handling certain end-of-life matters.
Who should you choose as a health care proxy?
Your health care proxy must be an adult of sound mind who is at least 18 or 19 years old (depending on the state). Choose someone you trust deeply, who understands your values, is comfortable discussing difficult medical decisions, and will honor your wishes even under pressure. It is helpful to select a person who can handle input from family members and healthcare providers and is willing and able to step in if needed. This person can be a spouse but does not need to be. Upon reflection you may determine that your adult child or someone else is better suited to handling the role. Some people choose a trusted friend, neighbor, or lawyer. Before naming someone as your health care proxy, have a conversation with them to be sure they understand your wishes and are comfortable taking on the responsibility. It can be helpful to name an alternate proxy as well.
When does a health care proxy take effect?
A health care proxy takes effect when a physician determines you are unable to make your own medical decisions.
How do you obtain a health care proxy?
Typically, you can download a form from your state’s department of health website. Here is the form from the New York State Department of Health: proxy.pdf Alternately, your healthcare provider or an estate planning attorney can provide you with the form. Once you have filled out the form, it must be signed in front of two witnesses who are not your proxy.
You can change your health care proxy at any time as long as you are able to communicate and make your own medical decisions. You can do this by filling out a new form. Destroy the old one and notify healthcare providers and family members.
2. Living Will
A living will is a legal document that outlines your preferences for medical treatment if you are unable to communicate or make decisions for yourself. It allows you to specify which treatments you would want, which you would not want, and the circumstances under which those choices should apply. A living will is different from a last will and testament, which addresses how your assets are distributed and, if applicable, names guardians for minor children.
What does a living will cover?
In a living will, you can state your preferences about the use of emergency procedures to keep you alive. It can be helpful to discuss your decisions with your health care proxy so that they understand your choices. Your living will may contain instructions about:
- CPR
- Ventilators
- Pacemakers and implantable cardioverter-defibrillators (ICDs)
- Artificial nutrition and hydration
- Organ donation
When does a living will take effect?
Exact timing and rules may vary by state, but this document generally becomes effective when you are unable to make your own decisions, and your doctor confirms that you have an incurable condition.
How do you obtain a living will?
You can download forms from your state’s website. Here is the living will template for New York: livingwill-template-fillin.pdf Once completed, it must be signed in the presence of two witnesses who meet certain criteria. These forms do not typically need to be notarized, but this should be verified with your state’s rules.
You can update your living will at any time as long as you are able to communicate and can make your own medical decisions. Draft a new document and state that this revokes the old document. Have it witnessed and signed in accordance with your state’s rules and distribute it to healthcare providers and family members accordingly. Your financial advisor can help you with this process.
3. DNR (Do-Not-Resuscitate Order)
A DNR is a medical order instructing healthcare providers not to perform CPR if your heart stops. While you can include this preference in your living will, those instructions may not always be followed in an emergency without a formal DNR order. Emergency medical personnel who respond to you in a home setting are generally required to follow medical orders like a DNR, rather than legal documents such as a living will or health care proxy. Because rules can vary by state, it is important to confirm the requirements where you live.
When does a DNR apply?
A DNR prevents unwanted resuscitation efforts in emergency situations where cardiac or respiratory arrest occurs.
How do you obtain a DNR?
A do-not-resuscitate order is typically obtained through a discussion with your healthcare provider about your wishes and medical condition. This conversation may include you, your health care proxy, and family members. If you decide a DNR is appropriate, a physician or other authorized healthcare professional must write the order for it to be valid. Once completed, the DNR is placed in your medical record so that healthcare providers can follow your wishes in the event of an emergency.
You can revoke a DNR at any time as long as you can make and communicate your own medical decisions. This can be done by informing your healthcare provider verbally, submitting a written request, or physically destroying the form.
4. MOLST (Medical Orders for Life-Sustaining Treatment)
A MOLST (Medical Orders for Life-Sustaining Treatment) is a detailed medical order designed for individuals with serious or advanced health conditions. It outlines a patient’s preferences regarding life-sustaining treatments and is typically used for those who require ongoing care, such as in a long-term care setting, or who may be approaching the end of life.
While New York uses the term MOLST, similar forms exist in most states under names like POLST (Physician Orders for Life-Sustaining Treatment) or other variations. Although the name may differ, the purpose remains conveying treatment preferences into medical orders that healthcare providers must follow across care settings such as home, hospital, or a nursing facility. Because requirements can vary by state, it is important to review the specific form used where you live.
What is a MOLST form used for?
A MOLST form tells medical teams whether to attempt CPR, use a breathing machine, provide artificial nutrition, or focus entirely on comfort care.
How do you obtain a MOLST form?
A MOLST form is completed through a conversation between you, your healthcare provider, and if appropriate, your health care proxy or family members. Once your wishes regarding your care are clearly understood, a licensed physician, nurse practitioner, or physician assistant must complete and sign the form to make it a valid medical order.
You typically can void a MOLST/POLST form as long as you can make and communicate your own decisions. You can do this by destroying the document or by writing “VOID” across it. To alter a MOLST or POLST document an appropriate healthcare provider must sign a new updated form. Your care team can help you make changes.
Important Tips to Remember
These documents work together.
- Health Care Proxy = legal document = Who decides on your behalf if you become unable to communicate or make decisions
- Living Will = legal document = What you want
- DNR/MOLST = medical orders = Providers must follow
You remain in control of these decisions and can update or revoke these documents whenever you choose, as long as you are able to make and communicate your own medical decisions. It can be helpful to speak with a professional about all of your options. Medicare covers advance care planning as part of your “Welcome to Medicare” and yearly “Wellness” visit. Advance care planning coverage If you have private health insurance, you can check with them directly to see if they offer this type of coverage.
You may already have these documents in place as part of your overall estate plan, but a medical diagnosis is an important time to review them and ensure that they still reflect your wishes. Keeping these documents up to date can provide clarity, reduce stress for loved ones, and help ensure that your preferences are honored. Your financial advisor can be a valuable source of support during this time, offering compassionate guidance and helping you review and update your advance directives as part of your broader plan. If you would like to learn more about how we can help, please contact us.
