What an Advance Directive Actually Looks Like: Examples and Real Language

Most people know they should have an advance directive. Far fewer know what one actually says. Seeing the real language—not a legal description of it—is often what finally motivates families to sit down and complete the form.

This post shows you what advance directives and living wills actually look like, the key sections you'll find in most forms, and where to get free, state-specific forms you can use right now.

The Two Parts of an Advance Directive

An "advance directive" is an umbrella term that usually includes two distinct components:

1. A healthcare power of attorney (or healthcare proxy, or medical POA) — names a specific person to make medical decisions if your parent can't speak for themselves
2. A living will (or directive to physicians, or instruction directive) — documents your parent's actual treatment preferences in writing

Some states combine both into a single document called an "advance directive." Others use separate forms. Some states have very specific statutory forms; others accept any written document that meets certain requirements.

The most important thing to understand: the person named (the healthcare agent) and the written instructions work together. The agent uses your parent's written preferences as a guide, and can make judgment calls in situations the document doesn't specifically address.

What a Healthcare Power of Attorney Looks Like

Here is representative language from a healthcare power of attorney form, based on widely used statutory forms:

DESIGNATION OF HEALTH CARE AGENT

I, [Parent's Full Name], residing at [address], appoint the following individual as my agent to make health care decisions for me:

Agent: [Agent's Name] Address: [Address] Phone: [Phone Number]

If this agent is unwilling or unable to serve, I appoint the following alternate agent:

Alternate Agent: [Alternate Name] Phone: [Phone Number]

AUTHORITY OF AGENT

My agent has full authority to make all health care decisions for me, including but not limited to:

• Consenting to or refusing any medical treatment, procedure, or service
• Deciding whether to continue, withhold, or withdraw life-sustaining treatment
• Authorizing admission to or discharge from any medical facility
• Requesting, reviewing, and receiving medical records
• Making decisions about organ or tissue donation

My agent shall make decisions consistent with my known wishes and in my best interest.

LIMITATIONS ON AGENT'S AUTHORITY (optional section)

I do not want my agent to authorize the following: [specify any limits, or leave blank]

This section is followed by the signature block, witness attestations (typically two witnesses who are not the agent, not relatives, and not healthcare providers), and in some states a notary acknowledgment.

The document is typically one to two pages. It names who has authority—it doesn't tell them what to do. That's what the living will adds.

What a Living Will Looks Like

A living will (sometimes called a "directive to physicians" or "instruction directive") is where your parent's actual wishes are documented. The language varies significantly by state, but most living wills cover the same core scenarios.

Here is representative language from a plain-language living will, based on commonly used statutory forms:

STATEMENT OF WISHES

If I am in a terminal condition, permanently unconscious, or have an end-stage condition, and I am unable to make my own health care decisions, I want the following:

Life-Sustaining Treatment:

[ ] I want all possible treatment to prolong my life.

[ ] I do NOT want life-sustaining treatment if it would only delay the moment of my death. This includes CPR, mechanical ventilation, and artificial nutrition and hydration.

[ ] I want life-sustaining treatment to be tried for a limited period. If there is no meaningful improvement within _____ days, I want treatment withdrawn and comfort care provided instead.

Artificial Nutrition and Hydration (feeding tubes):

[ ] I want artificial nutrition and hydration if I cannot eat or drink on my own.

[ ] I do NOT want artificial nutrition and hydration if I am terminally ill and death is expected within a short time.

[ ] I want artificial nutrition and hydration started and continued as long as it appears to provide comfort, but stopped if it appears to cause discomfort.

Comfort Care (Palliative Care):

In all circumstances, I want medication and treatment to relieve pain and keep me comfortable, even if this may hasten my death.

Additional Instructions: (free-text field)

I want to add the following:

Example entries families often write:

• "I do not want to be kept alive if I cannot recognize my family members."
• "I want to remain at home if at all possible, even if this means accepting more risk."
• "My religious beliefs are [denomination]. Please consult our clergy before making major decisions."
• "If there is any reasonable chance of recovery, I want treatment attempted."

My Goals and Values:

What matters most to me at the end of my life:

Example entries:

• "Being free of pain, even if it means I am less alert."
• "Being at home, not in a hospital or nursing facility."
• "Being able to communicate with my family."
• "Maintaining my dignity and not being kept alive in a state I would find undignified."

This is followed by signature, date, and witness requirements—the same as for the healthcare POA.

The Five Wishes Document

One of the most widely used advance directive forms in the United States is the Five Wishes document, published by the nonprofit Aging with Dignity. It is legally valid in 42 states and written in plain language designed to be completed without an attorney.

The Five Wishes covers:

1. The person I want to make care decisions for me — the healthcare agent designation
2. The kind of medical treatment I want or don't want — the instruction directive
3. How comfortable I want to be — pain management and comfort preferences
4. How I want people to treat me — personal care and dignity preferences
5. What I want my loved ones to know — messages, forgiveness, and final wishes

This fifth section—personal messages to family—is something most statutory forms don't include. For many families, this is what makes the document feel complete rather than purely clinical.

The Five Wishes costs $5 per copy or can be completed online for free. For families who want a document that covers both the legal requirements and the personal dimension, it's an excellent starting point.

Free Living Will Forms by State

Every state provides free advance directive forms. Here's where to find them:

National resources (all 50 states):

• CaringInfo.org — Free state-specific advance directive forms in plain language, available as downloadable PDFs. This is the most comprehensive free resource available and is maintained by the National Alliance for Caregiving.
• Five Wishes — fivewishes.org — $5 per printed copy, free online

State-specific examples:

Texas: Texas has a specific "Directive to Physicians and Family or Surrogates" form (commonly called the Texas advance directive) plus a separate "Medical Power of Attorney." Both are available free from the Texas Health and Human Services website. Texas requires two witnesses who are not the agent, not heirs, and not involved in the patient's care.

California: California uses a combined form called the "Advance Health Care Directive." It's available free from the California Attorney General's office. California's form includes space for special instructions and a section on organ donation.

Florida: Florida uses a "Designation of Health Care Surrogate" (healthcare POA equivalent) and a separate "Living Will." Both are available from the Florida Bar Association and the Florida Agency for Health Care Administration.

Other states: Search "[your state] advance directive form" or "[your state] living will form" — most state health departments or attorney general offices publish official forms.

Common Mistakes When Completing These Forms

1. Not using the correct state form. An advance directive valid in one state may not be automatically honored in another. If your parent splits time between two states, consider completing forms for both.

2. Incorrect witnessing. Most states have specific rules about who can witness—typically not the healthcare agent, not family members who would inherit, and not healthcare providers. Using the wrong witnesses can invalidate the document.

3. Storing it where no one can find it. A document in a safe-deposit box at the bank is inaccessible in an emergency. Originals should be kept at home in a known location, with copies given to the healthcare agent and the primary physician.

4. Not telling the agent they've been named. The named healthcare agent needs to know they've been designated, where the document is, and what your parent's general wishes are.

5. Completing the form but never talking about it. A written document can't capture every scenario. The healthcare agent will face situations the form doesn't address—so the conversation about values and preferences matters as much as the paper.

The Conversation That Makes the Document Useful

An advance directive tells medical staff what your parent doesn't want. The conversation you have with your parent tells you what they do want—the quality of life that matters to them, the line they don't want crossed, the place they'd rather be.

The End-of-Life Planner workbook includes conversation scripts designed specifically for adult children who need to open this topic with an aging parent—along with a worksheet where your parent can document their values and wishes in their own words. When the written document and the conversation align, the healthcare agent can act with confidence rather than guessing.

Getting the form is the easy part. The harder part is making sure everyone understands what it means and where to find it. Starting there is what actually protects your parent.