Advance Directive
Future wishes ≠ current medical orders.
What an Advance Directive Is
An advance directive is a legal document that records a patient's preferences for future medical care — typically covering resuscitation, mechanical ventilation, artificial nutrition, and other life-sustaining interventions. It speaks for the patient when the patient cannot.
The two most common forms are a living will (documents specific treatment preferences) and a healthcare power of attorney (designates a decision-maker). Many states combine both in a single document.
What It Is Not
An advance directive is not a medical order. It requires interpretation by the clinical team and cannot be acted on directly by EMS. A POLST is the order that results from translating those preferences into actionable instructions.
An advance directive is not a healthcare power of attorney — though many states include HCPOA designation within the same document. Know what your state's form covers.
The Practical Limitations
An advance directive is most useful when the healthcare team can find it, understand it, and connect it to current goals. A document completed 15 years ago, filed in a drawer, and never discussed may not reflect the patient's current wishes.
Revisit the advance directive when diagnosis, prognosis, or patient priorities change — not just at the initial encounter.
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Read the Deep Dive