Most families don’t start talking about end-of-life medical care because everything feels urgent and frightening. They start talking because of something quieter: a news story that hits close to home, a health scare, a parent’s hospital stay, or a nagging thought of, “I don’t want my family to have to guess.”
That is exactly what advance directives, living wills, and healthcare powers of attorney are designed to prevent. They are tools for love as much as for law—ways to say, “Here is what I would want, and here is who I trust to speak for me,” long before anyone is standing in an ICU hallway trying to make impossible decisions.
As you think through your own medical wishes, it can also be helpful to zoom out and see them as part of a bigger picture: your values, your preferred care, and eventually your choices around funeral and memorial plans. Today, most Americans ultimately choose cremation; organizations such as the National Funeral Directors Association note that cremation has become the most common choice nationwide, with rates continuing to rise over time.
Putting your medical wishes in writing now makes it much easier for your family to honor both the care you want while you’re alive and the way you’d like to be remembered afterward.
Why planning ahead for medical decisions matters
An advance directive does not cause a crisis; it prepares you and your family for one. When serious illness, accident, or advanced dementia makes it hard or impossible to speak for yourself, medical teams still must act. Without guidance, they default to doing everything that might help, even if that means aggressive treatments you would never have wanted. Families, meanwhile, are left trying to interpret half-remembered conversations and may disagree with one another.
Health organizations like the National Institute on Aging describe advance directives as legal documents that spell out your preferences for medical care and only take effect if you cannot speak for yourself. They are meant to reduce confusion and conflict and to give your loved ones a clear roadmap when emotions and stress are high.
Despite that, research shows many people still do not have anything in writing. Studies of U.S. adults suggest that only a minority have completed some form of advance directive or living will, which means many families are still making critical decisions in a fog of grief and uncertainty. Taking time now to think, talk, and write gives you back some control and eases that burden for the people you love.
What advance directives, living wills, and healthcare powers of attorney actually are
Advance directives in plain language
“Advance directive” is an umbrella term. It simply means written instructions about the medical care you would or would not want in situations where you cannot speak for yourself. Medical references like MedlinePlus and other NIH resources describe advance directives as documents that outline your preferences for major medical decisions and designate someone to speak for you.
Depending on your state, an advance directive may include:
- A living will (your treatment preferences)
- A healthcare power of attorney or healthcare proxy (the person you name to make decisions)
- Sometimes, specific forms related to DNR/DNI orders or other instructions
You can complete one or both parts—ideally, you have both your written wishes and a trusted person empowered to carry them out.
What is a living will?
A living will is not about money or property; it is about medical care. It usually addresses situations like being terminally ill, permanently unconscious, or in advanced dementia where recovery is extremely unlikely.
In a living will, you can express your wishes about:
- Use of ventilators and other forms of life support
- Feeding tubes and artificial hydration
- Attempts at resuscitation (CPR), and whether you would later want a DNR (Do Not Resuscitate) or DNI (Do Not Intubate) order
- Pain control, sedation, and comfort care even if it might shorten life
- Whether you prefer palliative care versus aggressive treatment when cure is no longer likely
Think of a living will as your chance to say, “If I reach a point where treatment is only prolonging the dying process, this is what I would want you to focus on instead.”
Healthcare power of attorney vs living will
A healthcare power of attorney (sometimes called a healthcare agent, healthcare proxy, or medical power of attorney) is the person you legally authorize to make medical decisions if you cannot. Many hospitals and organizations like the Mayo Clinic encourage every adult over 18 to choose such a person, even if they are currently healthy.
This document answers two crucial questions:
- Who do I trust most to speak for me?
- If the situation is not exactly described in my living will, who will interpret my values and make decisions in real time?
Ideally, your living will and healthcare power of attorney work together: your written guidance sets the framework, and your chosen person applies that framework to the situation at hand.
Common decisions your advance directive can cover
When you sit down with an advance directive form, the options can feel overwhelming. It often helps to imagine real-life scenarios: “If I were unlikely to recover in a meaningful way, what would I hope my care looked like?”
Most advance directives ask you to think about:
Life support and resuscitation. Would you want CPR if your heart stops? Would you want to be on a ventilator if doctors believe you are very unlikely to wake up or recover? This is where DNR and DNI preferences come in.
Feeding tubes and hydration. Some people feel strongly about not having long-term artificial feeding if there is no reasonable chance of improvement; others want these measures continued as long as possible.
Pain management and comfort. Many people say, “Keep me comfortable, even if strong medications might make me sleepy or could slightly shorten my life.” That is a way of prioritizing comfort-focused or palliative care over aggressive treatment when cure is no longer realistic.
Aggressive treatment vs palliative focus. In some situations, treatments may offer only a small chance of extending life, but come with significant side effects or time in the hospital. Your directive can indicate whether you would lean toward “try everything,” “focus on comfort,” or something in between, depending on the prognosis.
Organ donation and body donation. These decisions sometimes live on separate forms, but you can reference your wishes and make sure your healthcare proxy knows them.
You do not need to have medical training to answer these questions. You are not predicting every possible scenario; you are giving your loved ones a compass: Do you value trying every option, or avoiding prolonged suffering if recovery is unlikely? Do you want to spend as much time as possible at home if there’s a choice, or are you comfortable in a hospital setting if it means more treatment options?
Naming a healthcare proxy who can speak for you
Choosing a healthcare proxy or agent is as important as filling out the forms. This does not have to be the person who loves you “most”; it should be the person most able and willing to follow your wishes—even if that’s emotionally hard.
A good healthcare proxy is someone who:
- Understands your values and what “quality of life” means to you
- Can stay calm and ask questions in medical settings
- Will advocate for you with doctors and other family members
- Is willing to say “no” to treatments you would not want, even if others are pushing for more
Once you choose this person, tell them clearly that you are naming them, and why. Share your living will, talk through examples, and encourage them to ask questions. You can even rehearse difficult conversations: “If the doctors say I will not wake up in a meaningful way, I want you to prioritize comfort over more machines and procedures.”
It can also help to let other close family members know who your agent is and what your general wishes are. That way, it is less likely someone will be surprised or feel left out if a crisis comes.
How to complete and store advance directive documents
Finding the right forms for your state
Advance directive laws are state-specific, which means the form your neighbor uses in one state may look different from the form in another. Major health systems and organizations like the National Institute on Aging emphasize using forms tailored to your state and having them properly witnessed or notarized as required.
You can usually find state-specific forms:
- On your state’s department of health website
- Through local hospitals or clinics
- From reputable national organizations that provide state-by-state forms
Many people complete their forms at home and then bring them to a notary or their doctor’s office. Others complete them as part of an estate-planning visit with an attorney. Either approach is acceptable; the key is that the documents meet your state’s requirements and are signed correctly.
Where to store and share your paperwork
A beautifully completed advance directive that no one can find does very little good. Once your forms are signed:
- Keep the original in a safe but accessible place (not just a safe deposit box that’s hard to get into quickly).
- Give copies to your healthcare proxy and any alternate agents.
- Give a copy to your primary care doctor and, if possible, ask for it to be scanned into your medical record.
- If you’ve been treated at a specific hospital system, ask how they store advance directives so they appear quickly in an emergency.
You can also keep a simple card in your wallet that notes you have an advance directive and lists your healthcare agent’s contact information. Some people share digital copies in a secure family folder so adult children or partners can access them remotely when needed.
When to review and update your wishes
Advance directives are not one-and-done; they are living documents. Many experts recommend revisiting them whenever you hit what some call the “four D’s”:
- A new decade of life
- A significant new diagnosis
- A decline in health or function
- A major death in the family or close circle that changes how you think about care
You may find that your preferences shift over time. In your 40s, you might say “do everything possible”; in your 70s, you might prioritize comfort and time at home. Updating your documents and telling your proxy about those changes is part of taking care of yourself and those who will be caring for you.
How medical wishes connect to funeral and cremation choices
Advance directives are focused on medical treatment while you are alive, but they naturally sit alongside other end-of-life plans: your will, your preferences for burial or cremation, and how you’d like your family to remember you.
As more Americans choose cremation, many families are also asking new questions about what to do with ashes and how to honor someone in a way that feels personal, not one-size-fits-all.
If you already know you’d prefer cremation, you can share that with your healthcare proxy and family and incorporate it into broader funeral planning conversations. You might talk about whether you’d like a simple cremation with a gathering later, or a full service followed by cremation; whether you’d want your ashes kept together in one urn or shared through small urns; and how you feel about keeping ashes at home versus scattering them.
Funeral.com’s guide on keeping ashes at home safely and respectfully walks through practical and emotional considerations if your family is drawn to a home memorial.
You may also want to note preferences like a quiet scattering or water burial ceremony, perhaps inspired by their article on what happens during a water burial ceremony if you love the ocean or lakes.
Some people already have ideas about specific memorial items they like. For example, you might be drawn to classic cremation urns for ashes, artistic glass cremation urns, or sharing ashes with family through small cremation urns and keepsake urns.
Others like the idea of cremation jewelry such as cremation necklaces, which hold a tiny portion of ashes so a spouse, child, or sibling can keep a discrete, wearable reminder close.
For families with animals they consider part of the family, those preferences might extend to pets as well. You can let loved ones know you would want your companions honored with thoughtful pet urns for ashes if they die before or after you. Funeral.com curates many styles, including pet figurine cremation urns and pet keepsake cremation urns, so families can match their memorials to the personality of a beloved dog or cat.
These choices are deeply personal. Some people want a single, prominent urn on a mantel; others prefer smaller, quieter pieces that blend into home décor or a few coordinated keepsake urns plus a scattering ceremony. These are all part of a broader plan that grows out of the same values your advance directive is trying to express: What matters most to me? How do I define comfort, dignity, and meaning—for myself and for the people I love?
Costs, conversations, and taking the next step
One reason people delay both medical documents and funeral decisions is fear of cost. When it comes to medical care, an advance directive does not cost anything to complete in many states beyond notarizing or witnessing, yet it can have a powerful effect on whether you receive care that matches your values or care that feels unwanted.
On the funeral side, questions like “how much does cremation cost” are common and reasonable. National statistics suggest that the median cost of a funeral with cremation is typically lower than a traditional funeral with burial, though prices vary by region and by the services you include. Funeral.com’s guide to how much cremation costs and budget-friendly options breaks down what’s included in a basic package, what urns and memorial items might add, and how to prioritize the elements that matter most to your family.
Talking about these topics rarely feels easy, but many families say that once they finally sit down and have the conversation—about ventilators and feeding tubes, about what to do with ashes, about who will hold the key documents—it brings relief rather than more fear. You do not have to tackle everything in one sitting. You can start by reading your state’s advance directive form and marking anything that feels obvious to you, scheduling a time to talk with the person you’d like to name as your healthcare proxy, and jotting down a few notes about how you feel regarding cremation, memorials, keeping ashes at home, or water burial, even if you are not ready to choose a specific urn or ceremony yet.
Over time, those notes and conversations become a clear plan. Your future self—and your future grieving family—will be grateful you took those steps when you had the space and clarity to do so.
