Living will and advance directive: what to put in it and how to sign it in your state

Living will, health care agent, DNR: the three documents

People use advance directive, living will and health care directive for the same thing, but the law sees three different papers. Federal law defines an advance directive as a written instruction, such as a living will or durable power of attorney for health care, recognized under state law. 42 U.S.C. § 1395cc(f)(3)

• A living will: your treatment wishes. It tells which treatments you want if you are dying or permanently unconscious, in the words of the National Library of Medicine. California calls it instructions for health care (Part 2 of its form), Texas a directive to physicians, Florida a living will or declaration. New York has no living will statute, but its courts uphold wishes shown by clear and convincing proof, and a written statement is the most convincing.MedlinePlus · Cal. Prob. Code § 4701 · Tex. Health & Safety Code § 166.031 · Fla. Stat. § 765.101(13) · NYSBA
• A health care agent: who decides. A power of attorney for health care (California), medical power of attorney (Texas), health care surrogate (Florida) or health care proxy (New York) names a person to make decisions when you can't. In California both parts sit in one form. How to appoint an agent, what the agent may do and the signing rules for that document are on Power of attorney, so this page does not repeat them.Cal. Prob. Code § 4701 · N.Y. Pub. Health Law § 2981
• A DNR order or POLST: a doctor's order. A do-not-resuscitate (DNR) order instructs the health care team not to use cardiopulmonary resuscitation (CPR) if your breathing or heartbeat stops, as the National Cancer Institute puts it. It is a medical order: a physician signs it, usually when you are already seriously ill. Some states also use a portable physician order for other treatments, called POLST in Washington, that goes with you from one care setting to another. See doctor's orders below.National Cancer Institute · Tex. Health & Safety Code § 166.081 · Fla. Stat. § 401.45(3)(a) · Washington State Department of Health

What a living will can say

The official forms ask you the same questions in different words. The National Library of Medicine lists the common choices: the use of dialysis and breathing machines, whether you want to be resuscitated if your breathing or heartbeat stops, tube feeding, and organ or tissue donation. MedlinePlus

• Whether to prolong your life, and when. California's form offers two choices: not to prolong life if you have an incurable and irreversible condition that will result in death within a relatively short time, if you become unconscious and will not regain consciousness, or if the burdens of treatment outweigh the benefits; or to prolong life as long as possible within generally accepted health care standards. Texas asks separately about a terminal condition (death expected within six months even with treatment) and an irreversible condition. Florida's form covers a terminal condition, an end-stage condition and a persistent vegetative state.Cal. Prob. Code § 4701 (2.1) · Tex. Health & Safety Code §§ 166.002, 166.033 · Fla. Stat. § 765.303
• CPR, a ventilator, dialysis. These are the life-sustaining treatments a living will usually addresses. Texas defines life-sustaining treatment as treatment that sustains the life of a patient and without which the patient will die; Florida's term is life-prolonging procedure.Tex. Health & Safety Code §§ 166.002(10), 166.033 · Fla. Stat. § 765.101(12)
• Artificial nutrition and hydration (tube feeding). Say what you want. Florida counts artificially provided sustenance and hydration as a life-prolonging procedure, so it is withheld with the rest unless you say otherwise. Texas counts artificially administered nutrition and hydration as life-sustaining treatment and invites you to list it under additional requests. In New York your agent cannot decide about artificial nutrition and hydration at all unless your wishes are reasonably known.Fla. Stat. § 765.101(12) · Tex. Health & Safety Code §§ 166.002(10), 166.033 · N.Y. Pub. Health Law § 2982(2)
• Pain relief and comfort care. California's form directs that treatment for pain or discomfort be provided at all times, even if it hastens your death, unless you state an exception or strike that wording. Florida's form asks to be permitted to die naturally with only the medication or procedures needed for comfort care or to alleviate pain.Cal. Prob. Code § 4701 (2.2) · Fla. Stat. § 765.303
• Organ donation. California's form has an optional part to give your organs, tissues and parts at death, for transplant, therapy, research or education, and says leaving it blank is not a refusal: your donor registration is followed, or your agent may decide. A New York health care proxy may also state your wishes about organ and tissue donation, and leaving them out is not read as a wish not to donate. Texas suggests a separate directive for organ and tissue donation.Cal. Prob. Code § 4701 (3.1) · N.Y. Pub. Health Law § 2981(5)(f) · Tex. Health & Safety Code § 166.033
• Religious wishes and anything else. Every form leaves space for your own words: other wishes in California, additional requests in Texas, additional instructions in Florida. In New York the agent must follow your wishes, including your religious and moral beliefs, so write them down. Texas lets you add directions other than the ones printed on the form.Cal. Prob. Code § 4701 (2.3) · Tex. Health & Safety Code § 166.032(c) · Fla. Stat. § 765.303 · N.Y. Pub. Health Law § 2982(2)

Who can make one, and when it takes effect

Any competent adult. Texas: a competent adult may at any time execute a written directive. Florida: any competent adult may, at any time, make a living will. New York: a competent adult may appoint a health care agent, and every adult is presumed competent. New York's law counts as an adult anyone 18 or older (or who is a parent or has married), and in Texas a directive for a patient younger than 18 is signed by a parent, an adult spouse or a guardian. California's form has the witnesses declare that you appear to be of sound mind and under no duress, fraud or undue influence. Tex. Health & Safety Code §§ 166.032(a), 166.035 · Fla. Stat. § 765.302(1) · N.Y. Pub. Health Law §§ 2980(1), 2981(1) · Cal. Prob. Code § 4701 (5.3)

It takes effect only when you cannot decide for yourself, and a doctor confirms it. Until then you make your own decisions, and you can change the document.

• California: your agent's authority begins when your primary physician determines that you are unable to make your own health care decisions, unless you mark the box that makes it effective immediately. Cal. Prob. Code § 4701 (1.3)
• Texas: your attending physician must diagnose and certify in writing that you have a terminal or irreversible condition, which makes you a qualified patient, and must determine that the steps proposed accord with your existing desires before withholding or withdrawing life-sustaining treatment. Your own wishes at the time always come first. Tex. Health & Safety Code §§ 166.031(2), 166.037, 166.040
• Florida: before acting on a living will, it must be determined that you do not have a reasonable medical probability of recovering capacity, and that you have a terminal condition, an end-stage condition or are in a persistent vegetative state. Your primary physician and at least one other consulting physician must each examine you and sign their findings in your medical record. If there is a dispute and a review is not sought within 7 days of the physician's decision, the physician may proceed. Fla. Stat. §§ 765.304(1), 765.304(2), 765.306
• New York: the attending practitioner determines, to a reasonable degree of medical certainty and in writing, that you lack capacity; for a decision to withhold or withdraw life-sustaining treatment, a second physician, physician assistant or nurse practitioner must confirm it. If you regain capacity, the agent's authority ceases. N.Y. Pub. Health Law § 2983

How to sign a living will in California, Texas, Florida and New York

Each state publishes the form in its statute or through a state agency, and each sets its own witness rule. The generator at the top of this page follows these forms; here are the rules behind it.

• California: the statutory form, 2 witnesses or a notary. The Advance Health Care Directive form in Probate Code § 4701 has a power of attorney for health care (Part 1), instructions for health care (Part 2), organ donation (Part 3), your primary physician (Part 4) and the signature (Part 5); the Attorney General publishes it as a fillable PDF. Sign and date it, then either 2 qualified witnesses sign, or you acknowledge it before a notary public. A witness may not be your agent, your health care provider or its employee, or the operator or an employee of a community care facility or a residential care facility for the elderly, and at least one witness must declare that they are not related to you by blood, marriage or adoption and are not entitled to any part of your estate. A patient in a skilled nursing facility also needs a patient advocate or ombudsman as a witness. A copy has the same effect as the original. The courts' self-help site says notarization costs about $15.Cal. Prob. Code §§ 4701, 4675 · California Courts
• Texas: the directive to physicians, 2 witnesses or a notary. The form in Health and Safety Code § 166.033, titled Directive to Physicians and Family or Surrogates, is published by Texas HHS in English and Spanish (effective May 2024). You sign in the presence of 2 witnesses who qualify under § 166.003, or you sign and have your signature acknowledged before a notary public instead. Each witness must be a competent adult, and at least one must not be the person you named to decide for you, a relative by blood or marriage, an heir, your attending physician or the physician's employee, a facility employee giving you direct care or a facility officer, or a person with a claim against your estate. A directive signed before witnesses needs no notary, and no doctor or facility may require notarization or its own form.Tex. Health & Safety Code §§ 166.003, 166.032(b), (b-1), 166.033, 166.036 · Texas HHS
• Florida: the suggested form, 2 witnesses, no notary. A living will may, but need not, be in the form in § 765.303. It must be signed by you in the presence of 2 subscribing witnesses, one of whom is neither a spouse nor a blood relative. If you are physically unable to sign, one of the witnesses signs your name in your presence and at your direction. Naming a surrogate in it is optional, and leaving that blank does not invalidate the living will; if you do name one, Florida's surrogate law says the surrogate shall not act as a witness. No notary is required. A properly made living will establishes a rebuttable presumption of clear and convincing evidence of your wishes.Fla. Stat. §§ 765.302, 765.303, 765.202(2)
• New York: no living will statute, so sign it like a health care proxy. New York has no statute recognizing living wills, but its courts uphold wishes shown by clear and convincing proof; the New York State Bar notes that written wishes are much more convincing and that 2 independent witnesses are good practice for a separate living will. The Health Care Proxy statute requires your signature and date in the presence of 2 adult witnesses who also sign and state that you appeared to sign willingly and free from duress; the person you appoint as agent may not be a witness, and special witness rules apply in some mental health facilities. New York does not require a notary. The proxy may include your wishes, and written wishes do not revoke it: they are evidence of your wishes for your agent.N.Y. Pub. Health Law §§ 2981(2), 2981(5)(b), 2985(1)(d) · NYSBA

Other states have their own forms and witness rules, and the National Cancer Institute's advice applies everywhere: each state has its own laws regarding advance directives, so follow the law of the state where you live or are being treated. Florida accepts a directive signed in another state in compliance with that state's law or Florida's, and New York honors an out-of-state proxy that complies with the law of the state where it was made. National Cancer Institute · Fla. Stat. § 765.112 · NYSBA

DNR orders and POLST: doctor's orders for the seriously ill

A living will speaks for you; a DNR order speaks to the paramedics. It is a medical order, so a physician signs it, and in Texas, Florida and New York the state sets the form so that emergency crews recognize it.

• Texas: the out-of-hospital DNR order. A competent person may at any time execute a written out-of-hospital DNR order directing health care professionals acting in an out-of-hospital setting to withhold cardiopulmonary resuscitation and certain other life-sustaining treatment, such as advanced airway management, artificial ventilation, defibrillation and cardiac pacing. It never withholds comfort care, pain relief, water or nutrition. Your attending physician must sign it; you sign with 2 witnesses or before a notary. The state form (effective October 2023) and its instructions (updated May 2026) are on the Texas HHS site.Tex. Health & Safety Code §§ 166.081(6), 166.082 · Texas HHS
• Florida: the DNRO form. An order not to resuscitate, to be valid, must be on the form adopted by rule of the Department of Health and signed by your physician or physician assistant and by you, or, if you are incapacitated, by your health care surrogate, proxy, guardian or attorney in fact. Resuscitation may then be withheld or withdrawn by an emergency medical technician or paramedic who is shown the order.Fla. Stat. § 401.45(3)(a)
• New York, and POLST forms elsewhere. In New York your attending practitioner issues a nonhospital order not to resuscitate on a standard form prescribed by the state health commissioner, who may approve alternative forms that can also carry a do-not-intubate order; the New York State Bar suggests you may authorize your physician to issue a DNR order. Some states use a POLST form: Washington's health department describes it as a portable physician order form that summarizes your wishes on resuscitation, medical interventions, antibiotics and artificial feedings, and goes with you from one care setting to another. Ask your doctor which form your state uses; none of them replaces a living will or an agent.N.Y. Pub. Health Law § 2994-dd · NYSBA · Washington State Department of Health

Changing or revoking it, where to keep it, who gets copies

You can change your mind at any time. California's form says you have the right to revoke the directive or replace the form at any time. Texas lets you revoke without regard to your mental state or competency: destroy the document, sign and date a written revocation, or say so. Florida and New York accept a signed writing, destroying it, or telling your agent or a provider, and a later document revokes the earlier one. In Texas a revocation takes effect when your attending physician is told, and the word VOID is entered on each page of the copy in your medical record. Cal. Prob. Code § 4701 · Tex. Health & Safety Code § 166.042 · Fla. Stat. § 765.104 · N.Y. Pub. Health Law § 2985

Divorce. In Florida, ending your marriage revokes a former spouse as surrogate unless the directive or the divorce order says otherwise; in New York, divorce or legal separation revokes a spouse as agent unless you specify otherwise. See Family & divorce. Fla. Stat. § 765.104(2) · N.Y. Pub. Health Law § 2985(1)(e)

1. 1Keep the signed original where it can be found. The National Cancer Institute says to store copies in a safe place that's easy to access. Pick a place your family can reach at any hour.
2. 2Give copies to the people who will be asked. California: your physician, any other health care providers, any institution where you receive care, and any agent you named; a copy has the same effect as the original. Texas: your physician, usual hospital, and family or spokesperson. Florida: it is your responsibility to notify your primary physician, who must put it in your medical record. New York: your physician, agent and alternate agent, and carry a wallet card saying where the originals are.
3. 3Register it, if your state offers it. California's Secretary of State keeps an Advance Health Care Directive Registry under Probate Code § 4800; registering is optional, and the information is released to your health care provider on request.
4. 4Talk to your agent. California's form tells you to make sure your agent understands your wishes and is willing to take the responsibility. In New York, write down what you want about tube feeding: without knowing your wishes, the agent cannot decide it.
5. 5When you sign a new one, destroy the old one. And tell everyone who had a copy. In Texas, a revocation works only once your attending physician is told.

What hospitals must ask: the Patient Self-Determination Act

A federal law makes the question part of every admission. Hospitals, skilled nursing facilities, home health agencies and hospice programs that take Medicare must give adult patients written information about their rights under state law to make decisions about medical care, including the right to formulate advance directives, and about the provider's own policies. They must document in a prominent part of the medical record whether you have an advance directive, must not condition care on whether you have one or discriminate against you for it, and must educate their staff and the community about advance directives. The information is given at admission to a hospital or nursing facility, before home health care begins, at the start of hospice care, and at enrollment in a Medicare health plan. 42 U.S.C. § 1395cc(f)(1), (2)

Florida adds its own rule: facilities and providers must give each patient written information about the patient's rights concerning advance directives, may not require a patient to execute an advance directive, and face discipline for making one a condition of treatment or admission. Fla. Stat. § 765.110

What to say to your family and your doctor

Do I need a lawyer? Where to get help

The signing rules in these four states call for witnesses or a notary, not a lawyer; California's form explains itself, and the New York State Bar's pamphlet notes that a lawyer can give advice that ensures your documents are legally effective. Consider legal help if your family disagrees, if you live in one state and get care in another, if you want unusual limits on your agent, or if someone questions your capacity. Free legal aid and state bar referral services can review a form before you sign.

Common questions

Official sources

1. California Attorney General: the statutory Advance Health Care Directive form, Probate Code § 4701 in the version the Attorney General publishes (amended effective January 1, 2019) (agent 1.1-1.4, instructions 2.1-2.3, organ donation 3.1, effect of copy, statement of witnesses 5.3-5.4, skilled nursing ombudsman witness under § 4675, notary acknowledgment) (PDF) oag.ca.gov
2. California Attorney General: Advance care planning (no required form, Probate Code § 4701; who gets copies) oag.ca.gov
3. California Courts Self-Help Guide: Wills, estates, and advance care planning (the directive; sign before a notary or 2 witnesses; notary about $15) courts.ca.gov
4. California Secretary of State: Advance Health Care Directive Registry (Probate Code § 4800) sos.ca.gov
5. Texas Health and Safety Code, Chapter 166: Advance Directives (§§ 166.002(10), 166.003, 166.031, 166.032, 166.033, 166.035, 166.036, 166.037, 166.040, 166.042, 166.081, 166.082) tcss.legis.texas.gov
6. Texas Health and Human Services: Advance directives forms (living will, medical power of attorney, out-of-hospital DNR; notary option) hhs.texas.gov
7. Texas Health and Human Services: Directive to Physicians and Family or Surrogates (living will) form, English and Spanish, effective May 2024 hhs.texas.gov
8. Texas Health and Human Services: Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order form (effective October 2023) and instructions (updated May 2026) hhs.texas.gov
9. Florida Statutes § 765.101 (2026): definitions (advance directive, end-stage condition, life-prolonging procedure § 765.101(12), living will § 765.101(13), persistent vegetative state, terminal condition) flsenate.gov
10. Florida Statutes § 765.302 (2026): procedure for making a living will; 2 subscribing witnesses; notice to the physician; presumption of clear and convincing evidence flsenate.gov
11. Florida Statutes § 765.202 (2026): designation of a health care surrogate (the surrogate may not witness, § 765.202(2)) flsenate.gov
12. Florida Statutes § 765.303 (2026): suggested form of a living will flsenate.gov
13. Florida Statutes § 765.304 (2026): procedure for a living will (§ 765.304(1) when the physician may proceed and the 7-day review period; § 765.304(2) what must be determined first) flsenate.gov
14. Florida Statutes § 765.306 (2026): determination of patient condition (the primary physician and at least one other consulting physician separately examine the patient) flsenate.gov
15. Florida Statutes § 765.104 (2026): amendment or revocation of an advance directive; effect of divorce flsenate.gov
16. Florida Statutes § 765.110 (2026): health care facilities and providers must give written information and may not require an advance directive flsenate.gov
17. Florida Statutes § 765.112 (2026): recognition of an advance directive executed in another state flsenate.gov
18. Florida Statutes § 401.45 (2026): do-not-resuscitate orders on the Department of Health form, § 401.45(3)(a) flsenate.gov
19. New York Public Health Law § 2980(1): an adult is a person 18 or older, or a parent, or married nysenate.gov
20. New York Public Health Law § 2981: appointing a health care agent (competent adult § 2981(1); 2 adult witnesses and the agent may not witness § 2981(2); wishes and limits § 2981(5)(b); organ donation § 2981(5)(f)) nysenate.gov
21. New York Public Health Law § 2982: rights and duties of the agent (your wishes, religious and moral beliefs; artificial nutrition and hydration only if your wishes are known) nysenate.gov
22. New York Public Health Law § 2983: determination of lack of capacity (attending practitioner, in writing; a second clinician for life-sustaining treatment) nysenate.gov
23. New York Public Health Law § 2985: revocation of a health care proxy; written wishes do not revoke it § 2985(1)(d); effect of divorce § 2985(1)(e) nysenate.gov
24. New York Public Health Law § 2994-dd: nonhospital orders not to resuscitate (standard form prescribed by the commissioner; alternative forms may also carry a do-not-intubate order) nysenate.gov
25. New York State Bar Association, LEGALease: Living wills and health care proxies (no living will statute; clear and convincing proof; 2 witnesses, no notary in New York; out-of-state documents; DNR orders; wallet card) nysba.org
26. 42 U.S.C. § 1395cc(f): the Patient Self-Determination Act duties of hospitals, nursing facilities, home health agencies and hospices; definition of advance directive govinfo.gov
27. MedlinePlus (National Library of Medicine): Advance directives (living will, health care proxy, the decisions a living will covers) medlineplus.gov
28. National Cancer Institute: Advance directives (DNR orders, state laws differ, copies, changing your mind) cancer.gov
29. Washington State Department of Health: Portable Orders for Life Sustaining Treatment (POLST), a portable physician order form doh.wa.gov

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