What Advance Directive Should I Use?

There are a number of different formats for advance directives, and no one form will work for everyone. For one thing, many states have a state-specific form that they prefer residents use. Some states (California, for example) combine a living will and a durable power of attorney for healthcare into a single document, while others require them to be filled out separately.

Additionally, most states have specific requirements for residents of nursing homes. For these reasons, if you move from one state to another, it’s a good idea to create a new advance directive. Similarly, if you spend a considerable amount of time in more than one state, you may wish to have an advance directive that is valid in each one.

States also have different laws around finalizing the documents.

Most require two witnesses, and some require notarization. To learn the requirements in your state, visit Nolo’s Finalization Requirements for Healthcare Directives. You can also download a copy of your state’s form(s), along with detailed instructions for filling them out, from AARP.

The website PREPARE, created by geriatrician Dr. Rebecca Sudore, is also an excellent resource that will walk you through the process of thinking through and sharing your wishes about end of life and then help you create a document that is legally binding where you live.

Still another option you may want to consider is the Five Wishes form, an advance directive created by the nonprofit Aging with Dignity in conjunction with the Robert Woods Johnson Foundation in 1996. It combines a living will and a durable power of attorney for health care in a single document. According to Aging with Dignity, the form has been used by over 25 million people worldwide. Its

popularity has been linked to its simple language and the fact that it addresses personal, emotional and spiritual needs as well as medical care. The form is available in 27 languages and Braille.

The Five Wishes document meets the legal requirements for an advance directive in 42 states as of this writing. The other eight states (Alabama, Indiana, Kansas, New Hampshire, Ohio, Oregon, Texas and Utah) require a statutory form. However, the Five Wishes form can be attached to that document as a guide.

Although Five Wishes is an appealing and user-friendly document, it has been criticized for its ambiguous language and “pro-life” slant. In fact, there is language in the document that might actually thwart your wishes regarding medical care at the end of life.

Specifically, Wish Number 2 (“My Wish For the Kind of Medical Treatment I Want Or Don’t Want”) includes the general instruction,

*I do not want anything done or omitted by my doctors or nurses with the intention of taking my life.” This instruction poses a very real conflict if you also check the box that says “I do not want life-support treatment” – a conflict that could prevent doctors from withholding or withdrawing life support because that would “intend” your death.

Our advice? Use the Five Wishes form if it suits your needs. Just be sure to cross out, date and initial the section noted above. Or you may use the statutory form for your state.

Sources

“Finalization Requirements for Health Care Directives”. Nolo. https://www.nolo.com/legal-encyclopedia/finalization-requirements-health-care-directives.html

“Find Advance Directives Forms By State”. AARP. https://www.aarp.org/caregiving/financial-legal/free-printable-advance-directives/#more-advanceddirectives

“Five Wishes: For Myself”. Five Wishes. https://www.fivewishes.org/for-myself/

“Taking bold leaps to transform health in our lifetime”. Robert Wood Johnson Foundation. https://www.rwjf.org/