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Estate Planning – How to Make Health Care Directives Work

Last update on: Aug 10 2020

Most advanced health care directives are not followed by doctors and loved ones. Studies consistently show that is the case, for a host of reasons. In last month’s visit we discussed why you need more than a Living Will in your estate plan to cover health care decisions. This month, let’s look at the steps you can take to increase the likelihood that your wishes are followed.

§ Put it all in one document. From last month’s visit, you know that a complete plan involves at least a health care power of attorney, living will, and perhaps a more detailed explanation of decisions you would want made in certain situations. You also can include requests for how you want to be made comfortable and be treated.

One solution is to include all this information in one document instead of in separate documents.

Traditionally the documents are separate because each developed gradually over time and as separate forms. But there is no reason you must separate the power of attorney, living will, and other instructions. In fact, it makes a lot of sense to roll all of these instructions into one document. There is less chance that a document will be misplaced or that providers will focus on one document and ignore the others.

Sample all-in-one documents are available, as Five Wishes, from Aging with Dignity (; 888-5-WISHES). Other versions are available from These organizations charge modest fees for the documents and say they have versions for each state.

§ Be sure it is valid. Some states require two witnesses for the documents to be valid. Others require three witnesses. Three states (North Carolina, South Carolina, and Tennessee) require the documents to be notarized. Be sure the documents are valid in your state. The sources in the box can help you prepare documents that are valid.

§ Don’t forget about travel. The law of wherever you are when health care is needed determines whether a document is valid. If you regularly live in or travel to other states, produce a document that is valid in the most restrictive state or prepare different documents that meet the requirements of different states.

§ Don’t keep it to yourself. Of course, few of us like to discuss these topics. To reduce disagreements and misunderstandings among those around you, it makes a lot of sense to discuss details with the people you designate as proxies and also with your loved ones. A major point of contention in the recent Terri Schiavo case was that different members of the family had different views of what Mrs. Schiavo desired. Remember that a document, not matter how detailed, cannot cover every possible situation. Your proxies need to know your general desires so they can make decisions in specific circumstances that reflect your wishes.

§ Consult different sources. You can find the official approved living will for your state online. But, as we discussed last month, these are bare bones documents. There are many other, more detailed sources available. Check the sources in the box nearby. Of course, an estate planning attorney also will have a form or different forms that have been developed over the years. Each attorney’s form is based on his or her own experience and philosophy. Consult several sources to get a taste of the available options and develop a form with which you are comfortable.

Help with Health Care Directives

General sources:
Aging with Dignity:; 888-5-WISHES
National Hospice & Palliative Care Organization:; 800-658-8898
Your state attorney general’s office
American Bar Association: Tool Kit for Health Care Advance Planning and Common Legal Myths About Advance Medical Directives.
Quicken WillMaker Plus
Kiplinger WillPower from H&R Block.
Web sites:



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