Health care directives don’t usually come up at the dinner table, but maybe they should. Over the past year, we’ve seen a sharp increase in questions about living wills, health care proxies, and how to make medical wishes legally clear. And it’s no wonder: new survey data shows that while the majority of Americans want control over end-of-life decisions, most haven’t documented those preferences in writing.
In my practice, I’ve witnessed the toll this can take on families, particularly when loved ones are left guessing, or worse, arguing about what someone “would have wanted.” That’s why health care directives are a crucial part of modern estate planning, especially in 2025.
Why Health Care Directives Are Essential Now
Advance directives spell out your preferences for medical care if you’re ever unable to speak for yourself. This can include whether you want to be resuscitated, placed on a ventilator, or receive artificial nutrition. These documents also let you name someone called a health care proxy or agent to make medical decisions on your behalf.
Despite their importance, most people don’t have one. A 2025 survey published in the American Journal of Nursing found that only about 37% of U.S. adults have completed a health care directive. And according to a Harris Poll, nearly half of Americans don’t even know what the term means.
But the consequences of inaction can be serious. Without clear directives, medical providers often default to aggressive treatment, even if it contradicts the patient’s wishes. And in the absence of a named agent, decision-making may fall to a court-appointed guardian, creating delays, stress, and the potential for family conflict.
Real-Life Consequences of Not Planning Ahead
Take the case of Lynne Chesley reported in The Wall Street Journal, whose living will was ignored by her sister until a court intervened, an ordeal that led to unwanted medical intervention and fractured family relationships. Unfortunately, this isn’t rare. When preferences aren’t documented, or when documents aren’t properly shared, families are left to make heart-wrenching decisions in crisis.
Even in less dramatic cases, a lack of preparation can burden loved ones with guilt, confusion, or disagreements about care. That’s why proactive planning is a gift to yourself and those you love.
What to Include in a Strong Health Care Directive
A strong directive does more than check legal boxes. It provides clarity and confidence when it matters most. Here's what experts recommend:
- A Living Will: This outlines your preferences for treatments like mechanical ventilation, artificial hydration, feeding tubes, resuscitation (CPR), and end-of-life palliative care. According to the Mayo Clinic, a living ensures your values, not standard hospital protocols, guide your treatment.
- Health Care Proxy (Medical Power of Attorney): This names someone you trust to make medical decisions if you can’t. A 2025 American Bar Association guide emphasizes choosing someone with emotional resilience, availability, and a clear understanding of your preferences.
- HIPAA Authorization: This grants your proxy access to your medical records. Without this, they may be shut out of essential health information at critical moments.
- POLST (Physician Orders for Life-Sustaining Treatment): For individuals with serious illness or frailty, this form—recognized by medical staff and EMS—translates your preferences into physician-signed orders. According to the National POLST office, 19 states have formally adopted POLST programs, with more expanding access in 2025.
- Values-Based Planning Tools: Documents like Five Wishes add personal dimensions, including comfort preferences, spiritual wishes, and how you’d like to be remembered. This holistic approach has been endorsed by organizations like the Aging with Dignity initiative and is legally recognized in more than 40 states.
- AI-Based Decision Tools: In 2025, tools like PreCare are gaining popularity for helping individuals evaluate scenarios before drafting documents. A recent arXiv study found that AI aids like these improved patient-clinician communication and increased directive completion rates by up to 23%.
- Accessibility: Legal directives must be shared, stored properly, and easily accessible in a medical emergency. That may mean uploading copies to your electronic medical record, using a medical alert service, or carrying a wallet card that signals their existence.
What You Can Do Today
1. Start the Conversation: Talk with your loved ones and health care providers about your values and wishes. You don’t need to have all the answers, just a willingness to begin.
2. Put It in Writing: Work with an estate planning attorney to ensure your directive is legally valid in your state. Requirements vary.
3. Choose the Right Proxy: This person should be someone you trust, who understands your preferences, and who is willing to advocate for your wishes.
4. Share Copies Widely: Give copies to your proxy, primary care doctor, and family. Don’t let your directive sit in a drawer.
5. Revisit Regularly: Review your directives every few years or after major life changes, marriage, divorce, diagnosis, or loss of a loved one.
Conclusion
A health care directive isn’t just another document—it’s a vital safeguard for your autonomy and peace of mind for your family. It ensures that your medical care reflects your values, not someone else’s assumptions.
At Bascom Law, we believe that estate planning should care for the whole person, not just their assets. If you’d like help creating or updating your health care directive, we’re here to guide you through the process with clarity and compassion.
To schedule a consultation, visit BascomLaw.com or call 770‑285‑5493.
Sources
Ameriprise: Health Care Concerns in Estate Planning
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