Why All Adults Should Have a Living Will

Clear, written health care direction is a gift to those who love you

Amanda Singleton,

AARP

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En español

Published August 14, 2019

/ Updated June 11, 2024

a caregiver sits at a table with an older couple, helping them fill out paperwork

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“Her living will takes over now,” the nurse practitioner said the morning after my mother slipped into a coma.

I was 51 weeks into 24-hours-a-day caregiving, which included constant decision-making about hospital, rehab and nursing facility admissions, as well as readjustments of medication and treatment plans — without a break. Practically every day of caregiving held life-or-death choices.

Suddenly, there were no more decisions to make. All I had to do was be a daughter, to hold my mother’s hand, sing and talk to her, and wait. And when she died, my heart, mind and soul were at peace. My mom’s living will said she did not want life support or to be kept alive when there was no chance that she could survive without life support.

After examination and deliberation by her physicians, her final wishes were honored and carried out. It’s what she wanted. But her living will was also a gift to me, because without it, I wouldn’t have been able to let go and know that beautiful peace.

Why it matters

There are many reasons to make a living will: to give guidance to your doctors and health care surrogates, to provide clarity and closure to your loved ones, to prevent conflict or disagreements among family members and to limit the emo tional burden on the people closest to you at the time of your death.

Most important is that you remain the captain of your own ship, with the authority to dictate how you want to live and die. Considering that the majority of dying people are unconscious, in distress or otherwise not able to speak, the living will serves as your voice when you may not have one.

More than 80 percent of older adults understand the end-of-life transition is an important part of life, but only 33 percent have made a living will, according to a 2024 AARP survey. That means a majority of Americans are rolling the dice on who will make decisions for them at the end of their lives.

What is a living will

A living will, part of your advanced directive, is a written, legally binding document that informs your doctors about your preferences for medical care at the end of life. Because this is a legal document, you may use a lawyer to help you understand and write it. You do not need a professional, however. With a little research and reflection, you may create your own living will with ease and at no cost.

Every state has different laws and practices, so be sure to use a living will that your state recognizes. Some use standard forms; others allow you to draft your own. Follow your state’s rules about what kind of witnesses you should use and whether the document needs to be notarized.

What to include in your living will

In general, your living will should have:

A standard direction that you do not want life-prolonging procedures administered or continued if there is no probability of your survival.
More specific directions about what care you do or do not want (for example, dialysis, mechanical ventilation to assist with breathing, artificial hydration and nutrition or CPR).
Anatomical gift decisions (meaning whether you wish to be an organ and tissue donor or donate your body to science or education).
Palliative care wishes (such as whether you wish to die at home or avoid invasive tests or procedures).
Spiritual and religious considerations (your faith may have its own directions for how to create a living will).

Some people are concerned that doctors will not provide medical care if they have a living will. Remember: This is intended only to be an end-of-life document. It does not prevent routine medical treatment or care for conditions that are not life-threatening.

Your living will is not a script. One document can’t anticipate every possible scenario and dictate exactly how things will go.

Consider it more of a conversation (and that conversation may change, because your feelings about death may be different when you’re in good health than after a diagnosis of a terminal condition or debilitating disease).

How does a living will differ from a DNRO?

A Do Not Resuscitate Order (DNRO) is a doctor-created document that directs medical providers (EMTs, hospitals or nursing homes) not to attempt CPR if a patient is in cardiopulmonary arrest.

A living will is more complex. It serves as a complement to the DNRO and can be created at any time.

If you are seriously ill, discuss a DNRO and physician’s orders with your doctor.

You may want to discuss documents such as portable medical orders. These go by different names in different states and are sometimes known as POLSTs (Physician Orders for Life Sustaining Treatment), MOLSTs (Medical Orders for Life Sustaining Treatment), POSTs (Physician Orders for Scope of Treatment) or MOSTs (Medical Orders for Scope of Treatment). They tell your providers what treatments you want if you can’t consent to your medical care and are portable — they can be used whether you are in a hospital, nursing home, hospice or at home.

When should you write a living will?

Do not wait until confronted with an illness to create a living will. The unexpected can happen at any time, so write your living will when you’re in good health, but review and update it as needs and conditions change.

Remember that the doctor-created forms (DNROs and physician orders) will not come into play until you and your doctors agree you need them, when faced with serious illness or advanced frailness.

Where should you keep a living will?

As you put together your documents, talk to your doctors about your wishes. Have them put your living will on file, or consider placing it in a registry.

Speak with your closest family and friends, particularly those who may be your caregivers one day, so they know what your wishes are, and provide them copies of the living will.

Having these talks and writing your living will ensures that you live according to your own terms until your last breath, while giving your loved ones a sense of peace when it matters most.

Where should you keep your DNRO?

Emergency personnel need to be able to find a DNRO and other documents if you have a life-threatening event.

Patients are advised to put such documents on their refrigerator or in their medicine cabinet if they live at home. Keep a copy in your purse or wallet as well. If you reside in a facility or are hospitalized, there should be a copy in your file.

Editor's note: This article published on Aug. 14, 2019, has been updated with a new section on DNROs by the writer.

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Amanda Singleton is a recipient of CareGiving.com's national Caregiving Visionary Award and serves caregivers across their life span through her law practice. Follow her on Twitter/X and Facebook.