Do only seriously ill people need advance directives?
No. The National Cancer Institute's sentence is short and unconditional: all adults should have advance directives. It adds that the best time to fill them out is while healthy, in case illness or incapacity comes later.
Advance directives are legal papers stating what medical care a person wants if they cannot say so themselves, and who is trusted to make sure those wishes are followed.
The two documents, and what each one does
They are not interchangeable, and most people need both.
A living will states whether certain kinds of medical care are wanted if the person cannot speak for themselves. NCI lists what it usually covers: machines used to keep a person alive, such as dialysis machines and ventilators; do not resuscitate orders, which tell the team not to use CPR if breathing or the heartbeat stops; tube feeding; withholding food and fluids; and organ and tissue donation.
A durable power of attorney for health care names another person to make medical decisions. NCI notes its other names, which is useful because forms use different ones: health care proxy, medical power of attorney, health care agent, surrogate.
The second document does something the first cannot. A living will can only answer questions somebody thought to ask in advance. A named person can answer the ones nobody anticipated.
Why healthy is the right time
NCI's reasoning is practical rather than sentimental. Choices about end-of-life care are hard even when a person is well. Once someone is already seriously ill, the same decisions can seem overwhelming.
There is a second reason. Making these choices while healthy reduces the burden on the person and on their family later.
NCI lists what talking about it does: wishes become known and can be followed, family members are often comforted by knowing what is wanted, relatives are spared having to raise the subject themselves, and the person keeps the decisions rather than leaving them to someone else.
If that conversation is too hard, NCI suggests a family meeting with a social worker or a member of a faith community there to guide it.
The state-law trap
This catches people who move or who get treated out of state.
Each state has its own laws. NCI warns that a living will or durable power of attorney accepted in one state may not be accepted in another, and that the laws of the state where a person lives, or is being treated, are the ones that matter.
NCI points to two practical routes. State-specific forms can be downloaded from the National Hospice and Palliative Care Organization. And the Five Wishes program, created by Aging with Dignity with help from the American Bar Association, offers an easy-to-read living will. Its digital version is legal in all 50 states and the District of Columbia. The paper version is legal in all 50 states and available in 30 languages, though extra steps may be needed in New Hampshire, Kansas, Ohio, and Texas.
Five Wishes also publishes versions for younger people: Voicing My Choices for adolescents and young adults, and My Wishes for children.
After signing
NCI lists the steps that get skipped. Review the documents with a doctor or another member of the care team for accuracy before signing. Most states require a witness at the signing. Give copies to the doctor, the hospital, and family members. Store copies somewhere safe and easy to reach. And carry a card in a wallet saying the documents exist and where they are.
Nothing is permanent. NCI says a person can change their mind at any time, and that the conversation should be ongoing rather than a one-time event. When new directives are signed, the old ones should be destroyed.
One reassurance is worth stating plainly, because NCI does. Choosing to stop treatment aimed at the disease does not stop medical care. Palliative care continues, including treatment for pain and other physical symptoms, and support for psychological and spiritual needs. Our guide to advance directives and planning covers the forms, and advance care planning covers the conversation.
NCI's page was last updated on November 6, 2024.
Sources
Want the full picture? Read our complete explanation: Advance Directives and Planning Ahead
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