How to Get and Fill Out a Catholic Advance Directive Form

A Catholic advance directive form is a legal document that names someone to make your medical decisions and records your treatment wishes in line with Catholic moral teaching. You can download one for free from many dioceses or buy a national sample from the National Catholic Bioethics Center, but whichever form you use has to satisfy both the moral framework in the U.S. bishops’ Ethical and Religious Directives and your state’s rules for witnesses, notarization, and proxy eligibility.¹

Where to Get the Form

Start with your own diocese. Many publish a free fillable PDF written to the execution rules of the states they cover. The Catholic Dioceses of Arlington and Richmond, for example, offer a form that includes healthcare agent appointment, moral instructions, organ donation, and a mental health care supplement.² The Archdiocese of Los Angeles provides a downloadable version as well.³ A locally drafted form is more likely to match your state’s witness and notary requirements without extra work on your part.

If your diocese does not publish one, the National Catholic Bioethics Center sells its Catholic Guide to End-of-Life Decisions, which contains sample advance directive and healthcare proxy forms, as a $3 PDF or print copy. The NCBC notes that the sample forms are a national starting point, so you will need to check your state’s execution requirements before signing.⁴

Choosing Your Healthcare Proxy

Your proxy is the person who will speak for you when you cannot speak for yourself. Pick someone who understands Catholic teaching on end-of-life care and is willing to stand on it under pressure from other family members. The second quality matters more than people expect. A proxy who agrees with your values in theory but folds emotionally when a sibling pushes back will not protect your wishes when it counts.

Most states require a proxy to be at least 18, with Alabama and Nebraska setting the age at 19, and of sound mind. General best practice is to avoid naming your treating physician or their employees, an owner or employee of your residential care facility, a government agency financially responsible for your care, or anyone already serving as proxy for ten or more other people.⁵ State rules vary; your state bar association or legal aid office can confirm what applies where you live.

Name at least one successor agent, two if you can, in case your first choice is unreachable or unable to serve. The Arlington/Richmond form includes fields for a primary agent and two backups with full contact information.² Explicitly authorize your proxy to consult with a priest or Catholic bioethicist on decisions in moral gray areas. One sentence to that effect gives your proxy a lifeline for situations the two of you never discussed in advance.

Writing the Medical Instructions

The medical instructions section is where a Catholic directive diverges from a standard living will. Rather than ticking boxes for “treat” or “don’t treat,” you are setting a moral framework your proxy and medical team will apply to whatever situation arises. The framework comes from the Ethical and Religious Directives, whose seventh edition was approved by the USCCB in November 2025 and replaces all previous editions.¹

Proportionate and Disproportionate Means

Catholic teaching distinguishes between proportionate (ordinary) and disproportionate (extraordinary) means of preserving life. A treatment is proportionate when it offers a reasonable hope of benefit without imposing an excessive burden on you, your family, or the community. It is disproportionate when the burden outweighs the benefit. You are morally obligated to accept proportionate treatment and free to decline disproportionate treatment.¹ The judgment about which category a treatment falls into belongs to you or your proxy, informed by medical advice.

In practice, this means avoiding blanket instructions like “use every possible treatment” or “stop all treatment.” Instruct your proxy to evaluate each intervention on its own merits, weighing realistic benefit against physical, emotional, and financial burden. Spell out any treatments you feel strongly about. Mechanical ventilation if physicians believe recovery is possible. Dialysis during a terminal illness. Resuscitation at advanced age. The more specifically you can describe your values, the less your proxy will have to guess.

Nutrition and Hydration

This is where confusion is most common, and getting it right matters. Directive 58 of the seventh edition ERDs states that there is, in principle, an obligation to provide food and water, including tube feeding, to patients who cannot eat on their own. That obligation extends to patients in chronic, presumably irreversible conditions such as persistent vegetative state, now called unresponsive wakefulness syndrome, who could live for an extended period with such care.¹

Tube feeding becomes morally optional in two situations: when it cannot reasonably be expected to prolong life, or when it would be excessively burdensome, for instance when complications from the feeding tube cause significant physical discomfort. As a patient approaches inevitable death from a progressive, fatal condition, nutrition and hydration may become disproportionate because they offer very limited ability to prolong life or provide comfort.¹ Reflect this nuance in your directive. A rigid “always provide tube feeding” instruction can trap your proxy at a moment when the feeding itself is causing you harm.

Pain Management

Catholic teaching permits aggressive pain management even when the medication carries a risk of shortening life, as long as the intent is to relieve suffering rather than to cause death. This is the principle of double effect, and it means your directive can and should instruct your proxy to prioritize comfort care. State clearly that you accept pain medication in doses sufficient to manage your symptoms, and that you understand the potential side effects. That instruction prevents well-meaning family or cautious physicians from undertreating your pain out of a misplaced sense that strong medication conflicts with Catholic values.

Euthanasia and Voluntarily Stopping Eating and Drinking

The ERDs are unambiguous: Catholic health care institutions may never participate in euthanasia or assisted suicide in any form. Directive 59 defines euthanasia as any action or omission that intentionally causes death to end suffering and directs that dying patients who request it should instead receive compassionate care, psychological and spiritual support, and appropriate symptom management.¹

The seventh edition adds Directive 60, which addresses voluntarily stopping eating and drinking. If a patient expresses an intention to refuse all food and water to hasten death, Catholic health care services will not facilitate that course of action and should, while respecting the patient’s freedom, try to dissuade the patient and continue providing appropriate pain management.¹ Make clear in your directive that declining a burdensome feeding tube near the end of life is not the same as refusing food and water as a means of ending your life.

Organ Donation

The Catholic Church has traditionally characterized organ donation as a generous act of solidarity when done ethically, meaning the donor or proxy has given explicit consent, a physician outside the transplant team has confirmed death, and the donation does not sacrifice an essential function of a living donor. Most Catholic directive forms include a section for organ donation preferences; the Arlington/Richmond form specifically appoints an agent to make anatomical gift decisions.²

Recent years have added complication. A coalition of Catholic professionals and ethicists has raised concerns that current medical criteria for determining brain death may not establish the “moral certainty” of death that Catholic teaching requires. Some now advise Catholics to document a refusal of organ donation until the ambiguities are resolved; others comfortable with the medical criteria may wish to spell out the specific conditions under which they consent.⁶ Whichever position you take, put it in writing. Leaving this section blank invites confusion when time-sensitive decisions are being made.

Requesting the Sacraments

Include a written request for the sacraments, particularly the Anointing of the Sick and Viaticum, which is Holy Communion given to someone near death. Hospital chaplains and pastoral care teams move faster when they can point to a signed instruction rather than relying on a family member’s verbal request during a crisis. If you have a preference for a particular priest or religious community, name them and include contact information. Some forms also include a request for family reconciliation and a preferred place of death if medically feasible.

Additional Instructions for Women

If you are a woman of childbearing age, pay attention to this section. More than half of U.S. states have pregnancy exclusion laws that can automatically suspend or invalidate a woman’s advance directive during pregnancy. The specifics vary. Some states void the directive entirely while pregnant. Others only when the pregnancy could result in a live birth. About sixteen states and the District of Columbia do not address pregnancy at all in their directive statutes. No federal standard applies.

Catholic directive forms often address this head-on. The Arlington/Richmond form includes an “Additional Health Care Instructions for Women” section covering pregnancy and viability.² Look up your state’s pregnancy exclusion rule and address it explicitly in the additional instructions. Silence here can leave your directive overridden by a state law you never knew existed.

Signing the Form

An advance directive that has not been properly executed is just paper with opinions on it. State law sets the requirements, but the general pattern is your signature (or the signature of someone you direct to sign if you are physically unable), witnessed by two adults. Common witness restrictions exclude people related to you, named in your will, directly involved in your health care, or serving as your healthcare agent. Georgia, for example, explicitly bars anyone who stands to benefit from your death from witnessing. Some states require notarization; others accept witnesses alone.

If your state requires a notary, expect a fee typically under $20, though it varies. Many banks, UPS stores, and public libraries offer notary services. Attorneys who draft estate plans often notarize the directive as part of their service.

Once signed, federal law supports getting the document honored. The Patient Self-Determination Act requires hospitals, skilled nursing facilities, hospice programs, home health agencies, and HMOs that participate in Medicare and Medicaid to give you written information at admission about your right to accept or refuse treatment and to create a directive. The facility must document in your medical record whether you have one, and it cannot condition your care on whether you do.⁷

Distributing and Storing Copies

Distribution is what makes the directive functional. A beautifully completed form sitting in a safe deposit box helps no one during a 2 a.m. emergency admission.

Give the original or a certified copy to your primary agent and each successor agent, and walk them through it rather than just handing it over.
Provide a copy to your primary care physician for your electronic medical record, and confirm it has been scanned in rather than left in a paper file.
If you regularly receive care at a particular hospital, contact admissions or patient services to have the directive added to your record before you need it.
Make sure key family members know the directive exists, where to find it, and who your proxy is, even if you choose not to share the full document.
If you named a specific priest or spiritual advisor, give them a copy and confirm they know what you have asked of them.

Digital registries add a safety net. MyDirectives lets you upload advance care planning documents for free and provides access to hospitals and first responders through its ADVault Exchange system.⁸ Some states run their own registries through the Secretary of State’s office, with filing fees from free to about $10. A registry is not a substitute for physical copies in your proxy’s and physician’s hands, but it provides a backup if the paper version cannot be located quickly.

POLST Forms Are Not a Substitute

A POLST (Physician Orders for Life-Sustaining Treatment) or MOLST form is a separate medical order, signed by you and your physician, that translates your treatment preferences into actionable clinical instructions. Unlike an advance directive, which your proxy interprets, a POLST is a direct physician order that emergency responders and hospital staff can follow immediately. It does not replace your Catholic advance directive. You still need the directive to appoint a proxy and establish the moral framework for decisions the POLST does not cover.

Catholic opinion on POLST forms is not unanimous. Some bishops have warned that the risk of accidental or intentional euthanasia through a POLST is too serious to accept and have encouraged Catholics to avoid it. Others in Catholic healthcare argue that a thoughtfully completed POLST facilitates care consistent with the ERDs by communicating your wishes clearly to clinical staff. If you choose to complete one, treat it as the last step: first set your goals of care in your advance directive, then decide with your physician which specific interventions match those goals, then fill out the POLST. Nothing in the POLST should contradict the moral instructions in your directive.

Updating or Revoking the Directive

You can revoke your directive at any time and in any manner, verbally, in writing, or by physically destroying it. Signing a new directive generally revokes the prior one automatically unless the new document says otherwise. A written revocation is not legally required in most states, but it creates a cleaner paper trail. Reference the date of the original document so there is no ambiguity about what you are revoking.

After revoking, notify everyone who holds a copy: your proxy, successor agents, physician, hospital, and any registry. Ask for the old copies back and destroy them. If someone will not return their copy, give them written notice of the revocation so they can no longer rely on it in good faith. Your physician must document the revocation in your medical record once notified.

Review the directive every few years, and any time something significant changes: a new diagnosis, a change in your proxy’s availability, a move to a different state, or an update to the ERDs. The seventh edition approved in November 2025 added new language on voluntarily stopping eating and drinking and refined the brain death discussion.¹ If your directive predates that revision, read the new edition and update if anything has shifted.

When a Facility Will Not Honor Your Directive

Conflicts can run in either direction. A secular hospital may resist following Catholic-specific instructions, for example continuing tube feeding when the medical team believes it is futile. A Catholic hospital may decline to withdraw treatment that your directive permits declining under the disproportionate-burden standard because the facility interprets the ERDs differently than your proxy does.

In most states, a provider that refuses to honor your directive must make reasonable efforts to transfer you to another provider that will comply. Facilities with conscience-based objection policies are generally expected to inform you at admission. Individual physicians are not always required to disclose personal objections in advance, which is why it helps to have the conversation with your doctor before a crisis rather than during one.

Federal conscience protection laws, including the Church Amendments and the Weldon Amendment, protect healthcare providers and institutions from being compelled to participate in procedures like sterilization or abortion that conflict with their religious convictions.⁹ Those protections run both ways. They shield Catholic hospitals from procedures that violate Catholic teaching, and they mean a Catholic patient in a secular facility may need a well-prepared proxy to advocate firmly for faith-consistent care. The directive is your strongest tool in that situation, which is why precise, unambiguous language matters more than length.

1
United States Conference of Catholic Bishops. Ethical and Religious Directives for Catholic Health Care Services, Seventh Edition
2
Catholic Dioceses of Arlington and Richmond. Catholic Advance Medical Directives
3
Archdiocese of Los Angeles. Advanced Healthcare Directive
4
The National Catholic Bioethics Center. Catholic Guide to End-of-Life Decisions – PDF Download (English)
5
National Institute on Aging. Choosing A Health Care Proxy
6
John A. Hartford Foundation. Catholics United on Brain Death and Organ Donation: A Call to Action
7
Office of the Law Revision Counsel. 42 USC 1395cc – Agreements With Providers of Services
8
MyDirectives. MyDirectives – Advance Care Planning
9
U.S. Department of Health and Human Services. Your Rights Under the Federal Health Care Provider Conscience Protection Laws