Living Will vs Healthcare Proxy: What's the Difference?
These two documents are often confused, but they serve different purposes. Your parent needs both. This guide explains what each one does and how they work together.
The Quick Answer
Living Will
What it is: A document that states your parent's wishes for end-of-life medical treatment.
When it's used: When your parent is terminally ill or permanently unconscious and can't communicate.
What it does: Tells doctors directly what treatments your parent does or doesn't want (life support, feeding tubes, etc.).
Healthcare Proxy (Healthcare Power of Attorney)
What it is: A document that names someone to make medical decisions for your parent.
When it's used: When your parent can't make or communicate their own medical decisions (for any reason).
What it does: Gives a trusted person legal authority to make healthcare decisions on your parent's behalf.
Side-by-Side Comparison
| Living Will | Healthcare Proxy | |
|---|---|---|
| Also called | Advance directive, directive to physicians | Healthcare power of attorney, medical POA, healthcare agent |
| Names a person? | No | Yes — your "healthcare agent" |
| States specific wishes? | Yes | No (but the agent should know your wishes) |
| When it activates | Terminal illness or permanent unconsciousness | Any time the person can't make decisions |
| Flexibility | Limited — only covers pre-specified scenarios | High — agent can handle unexpected situations |
A living will tells doctors what your parent wants, but it can't cover every scenario. A healthcare proxy names someone who can make judgment calls when the living will doesn't give a clear answer—or when situations arise that weren't anticipated.
Living Will: What to Include
A living will typically addresses these decisions:
Life-Sustaining Treatment
- CPR (cardiopulmonary resuscitation): Attempt to restart the heart?
- Mechanical ventilation: Use a breathing machine?
- Artificial nutrition/hydration: Feeding tubes? IV fluids?
- Dialysis: Kidney treatment?
When These Preferences Apply
- Terminal illness with no chance of recovery
- Permanent unconsciousness (persistent vegetative state)
- Advanced dementia with no recognition of loved ones
Other Preferences
- Pain management priorities
- Preference for comfort care vs. aggressive treatment
- Organ donation wishes
- Where they want to die (home, hospital, hospice)
Healthcare Proxy: Choosing the Right Person
The person your parent names as their healthcare agent should be:
- Trusted: Someone your parent trusts completely to honor their wishes
- Available: Able to be reached and get to a hospital if needed
- Assertive: Willing to advocate firmly with doctors and family
- Able to handle stress: Can make difficult decisions under pressure
- Over 18: Must be a legal adult
The healthcare agent must understand your parent's wishes. Having the document isn't enough—they need to have had detailed conversations about what your parent would want in various scenarios.
Who to Name as Backup
The healthcare proxy should name alternate agents in case the first choice is unavailable, unwilling, or unable to serve. Typically:
- Primary agent (first choice)
- First alternate
- Second alternate (optional)
How They Work Together: An Example
Scenario: Your parent has a massive stroke and is on a ventilator. Doctors say there's a small chance of recovery, but if they do recover, they'll likely have severe disability.
- Living will says: "Do not keep me on life support if I'm terminally ill with no hope of recovery" — but is this situation covered? There's some chance of recovery.
- Healthcare proxy kicks in: You (as the named agent) talk to doctors, understand the specific situation, and make a decision based on what you know your parent would want.
The living will provides guidance. The healthcare agent makes the final call using that guidance plus their knowledge of your parent.
How to Create These Documents
Option 1: Attorney
An elder law attorney can draft both documents. Cost is typically $200-$500 for advance directives, often bundled with other planning documents.
Option 2: State-Specific Forms
Every state has its own forms that meet legal requirements. Many are free. Check:
- Your state's health department website
- CaringInfo.org — free state-specific forms
- Your parent's doctor's office may have forms
Requirements for Validity
Requirements vary by state but typically include:
- Your parent must be mentally competent when signing
- Two adult witnesses (who aren't beneficiaries or healthcare providers)
- Notarization may be required in some states
After Creating the Documents
- Give copies to: Healthcare agent, backup agents, primary doctor, specialists, local hospital
- Keep originals safe: Somewhere accessible (not a safe deposit box that's hard to access)
- Review periodically: Every few years or after major health changes
- Register if available: Some states have advance directive registries
Get Your Documents Organized
Our Estate Planning Workbook walks you through all the documents your parent needs, with conversation guides and checklists.
Get the WorkbookFrequently Asked Questions
Can my parent change their mind?
Yes. Both documents can be revoked or changed at any time, as long as your parent is mentally competent. Just create new documents and destroy old copies.
What if family members disagree with the agent's decision?
The healthcare agent's decision is legally binding. Other family members don't have authority to override them. This is why choosing the right person is so important.
Does a DNR replace these documents?
No. A DNR (Do Not Resuscitate) order is a specific medical order signed by a doctor. It's separate from advance directives but should be consistent with them. Some states have POLST (Physician Orders for Life-Sustaining Treatment) forms that serve as medical orders.
What if there's no advance directive and no healthcare proxy?
State law determines who makes decisions. Usually it's spouse first, then adult children. But without clear documentation, family conflict and legal battles can result.