A living will should spell out, in specific terms, which life-sustaining treatments you accept or refuse, the medical conditions under which those instructions take effect, your comfort care preferences, your organ and tissue donation wishes, and the signatures and witnesses your state requires to make the document enforceable. What should be included in a living will is driven by a single idea: vague instructions leave doctors guessing and family members arguing, so every section needs to be concrete enough that a stranger in scrubs can act on it.
Specific Life-Sustaining Treatments You Accept or Refuse
This is the core of the document. Address each of the common interventions by name rather than relying on a catch-all phrase. Writing “no heroic measures” without defining what that means gives doctors almost nothing to work with.
- CPR. Cardiopulmonary resuscitation uses chest compressions, rescue breathing, electric shocks, and medications to restart a stopped heart. State whether you want it attempted at all, or only in certain circumstances.
- Mechanical ventilation. A ventilator breathes for you through a tube in your throat. Say whether you want to be placed on one, and if so, for how long before it should be withdrawn.
- Artificial nutrition and hydration. Fluids and nutrients delivered through an IV or feeding tube when you can’t eat or drink. Accept, refuse, or accept for a limited time.
- Dialysis. Filtering waste from your blood when your kidneys fail. Specify whether you’d want it started or continued if kidney failure occurs alongside a terminal or irreversible condition.
- Other interventions. Blood transfusions, antibiotics for infections, and surgery can all be addressed the same way. More specificity means less room for disagreement.
DNR and DNI Preferences
Two terms worth knowing. A DNR (do not resuscitate) instruction tells medical staff not to perform CPR, chest compressions, or use cardiac drugs if your heart stops. A DNI (do not intubate) is narrower: it allows basic CPR and medications but prohibits a breathing tube. You can include either or both in your living will. It’s also smart to have your doctor write formal DNR or DNI orders in your medical chart each time you’re admitted to a new facility, since a living will sitting at home won’t help paramedics in the moment.
The Conditions That Trigger the Document
A living will doesn’t take effect the moment you sign it. It activates only when you can’t communicate your own decisions and you have a qualifying medical condition. Name the conditions you want to cover:
- Terminal illness. A condition where death is expected regardless of treatment, and life-sustaining measures would only delay dying rather than lead to recovery.
- Permanent unconsciousness. A persistent vegetative state or irreversible coma with no reasonable medical expectation that you’ll regain awareness.
- Late-stage dementia. Advanced cognitive decline where you can no longer recognize loved ones, communicate meaningfully, or perform basic functions.
- Serious irreversible injury. A catastrophic event such as severe brain damage where recovery to any meaningful function is not expected.
In most states, the determination that you meet one of these conditions must come from your attending physician, often confirmed by at least one additional doctor who has examined you or reviewed your case.1American Bar Association. Living Wills, Health Care Proxies, and Advance Health Care Directives Being specific about which conditions trigger your instructions prevents a situation where your living will is technically in effect but nobody agrees whether it applies.
Comfort Care and Pain Management
Declining life-sustaining treatment doesn’t mean declining all care. Say what kind of comfort you want during your final days. Palliative care focuses on relieving pain and symptoms rather than curing the underlying condition.
Preferences worth putting in writing include whether you want aggressive pain medication even if it might shorten your life, whether you’d prefer to die at home rather than in a hospital, and whether you want measures like ice chips for dry mouth or soothing music. You can also state that you want to avoid invasive tests or procedures that serve no comfort purpose.2National Institute on Aging. Preparing a Living Will If you have hospice preferences, include those too. The goal is a complete picture of what “comfortable” means to you, not just a list of treatments to avoid.
Organ and Tissue Donation Wishes
A living will is a natural place to record whether you want to donate organs, tissues, or your entire body after death. You can specify donation for transplant, for medical research, or both. If you want to exclude certain organs or tissues, spell that out.2National Institute on Aging. Preparing a Living Will
One practical detail: if you’re an organ donor and your organs are viable, medical staff will keep you on life support briefly after death to preserve them for retrieval. Noting your donation wishes helps your family understand why certain interventions continue briefly after death has been determined.
A Named Health Care Proxy
A living will handles the situations you can predict. A health care proxy handles everything else. A proxy (also called a health care agent or surrogate) is someone you authorize to make medical decisions on your behalf when you can’t, appointed through a durable power of attorney for health care. It’s a separate advance directive that works alongside your living will.3National Institute on Aging. Advance Care Planning – Advance Directives for Health Care
The reason this matters so much: a living will is static. It can’t adapt to medical situations you didn’t anticipate when you wrote it. A proxy can talk to your doctors in real time, weigh new information, and make judgment calls guided by your values. Some states combine both documents into a single advance directive form, but even if yours treats them separately, you should have both.
Your proxy must be at least 18 in most states (19 in Alabama and Nebraska) and mentally competent. Choose someone who knows your values, can handle pressure, and will advocate for your wishes even when other family members disagree. Avoid naming your own doctor, anyone who works at the facility where you receive care, or a court-appointed guardian.4National Institute on Aging. Choosing a Health Care Proxy
A Pregnancy Clause If It Applies to You
If you’re a woman of childbearing age, this is a detail most people never hear about. The majority of states have laws that restrict or override a living will if you happen to be pregnant when it would otherwise take effect. The restrictions vary. Some states completely invalidate your advance directive during pregnancy regardless of the circumstances. Others allow it to be overridden only if the fetus could potentially reach viability with continued treatment. A smaller group makes exceptions when continued life support would cause the mother severe pain that medication can’t control.
Check your state’s specific law and consider adding explicit language about whether you want your instructions followed during pregnancy. Some states require that kind of specific written statement before they’ll honor your directive in that situation.
Spiritual and Personal Preferences
Your living will can also reflect values outside clinical decisions. If your faith tradition has specific views on end-of-life treatment, blood products, or organ donation, document them. If you’d want a chaplain, priest, rabbi, imam, or other spiritual advisor present during your final hours, say so. These preferences aren’t legally binding in the same way that treatment instructions are, but they give your care team and family a fuller picture of what a dignified death looks like to you.
Signatures, Witnesses, and Notarization
A living will isn’t valid just because you wrote it down. Every state requires certain formalities, and skipping them can render the document unenforceable.
You must sign and date the document yourself, or if you’re physically unable, direct someone else to sign on your behalf in your presence. Most states require two adult witnesses to watch you sign and then add their own signatures. Witness restrictions are common: your witnesses generally cannot be related to you by blood or marriage, cannot stand to inherit from your estate, and cannot be financially responsible for your medical care.2National Institute on Aging. Preparing a Living Will These rules exist to prevent undue influence.
Notarization isn’t required everywhere, but having the document notarized can make it easier for hospitals and care facilities in other states to accept it without question. If you split time between two states or travel frequently, it’s worth the small effort. Some states also offer advance directive registries where you can file your living will electronically so health care providers can access it during an emergency.
A POLST for Emergencies
Here’s something that surprises most people: paramedics cannot honor your living will. When someone calls 911, emergency medical technicians are legally required to stabilize you for transport. They’ll perform CPR, intubate, and use every tool available regardless of what your advance directive says. Your living will only comes into play after you’ve been admitted and a physician has evaluated your condition.3National Institute on Aging. Advance Care Planning – Advance Directives for Health Care
If you have a serious illness or advanced frailty and want to avoid emergency resuscitation, ask your doctor about a POLST form (Physician Orders for Life-Sustaining Treatment, though different states use different names like MOLST or POST). A POLST is a set of medical orders signed by your physician that travels with you across care settings and is honored by emergency responders. It covers CPR, ventilation, feeding tubes, and other interventions. A POLST doesn’t replace your living will; it supplements it for situations the living will can’t reach.
Keeping Copies in the Right Hands
A living will locked in a safe deposit box might as well not exist. Once you’ve signed it, give copies to your health care proxy, your primary care doctor, and any close family members likely to be present during a medical crisis.2National Institute on Aging. Preparing a Living Will If you’re admitted to a hospital or nursing facility, the staff is required by federal law to ask whether you have an advance directive and to document that in your medical record.5Office of the Law Revision Counsel. 42 US Code 1395cc – Agreements With Providers of Services Bring a copy with you and make sure it goes into your chart.
Review the document every few years or after any major life change: a new diagnosis, a marriage or divorce, the death of your chosen proxy, or a shift in your personal values. You’re the only person who can revoke or change your living will, and you can do so at any time while you’re still competent. Drafting a new document and destroying the old copies is the cleanest approach, though most states also allow oral revocation in the presence of witnesses. Whatever method you use, make sure every person who has an old version receives the updated one.