Health care directives · 51 jurisdictions

Your medical wishes, legally executed and reachable when seconds count.

An advance directive puts your medical choices into writing and names someone you trust to speak for you if an accident or sudden illness leaves you unable to communicate.

Every state recognizes advance directives, but every state writes its own rules.

The legal name of the document, the required wording, who can witness your signature, and the exact moment the document takes legal effect differ across state borders.

Select your state below to see the statutory form your state recognizes, the signing requirements, who is disqualified from witnessing, and how the document becomes legally operative. WearableDocs hosts your executed directive behind a secure QR code on a card or wearable, so an attending emergency team can open and verify the actual signed instrument in seconds.

What an advance directive does

Most states structure advance care planning around two distinct legal functions, either combined into a single statutory form or handled as separate documents:

  • A living will (treatment instructions)Spells out which medical interventions you want and which you refuse if you face a terminal condition, end-stage illness, or persistent unconsciousness. This covers ventilators, cardiopulmonary resuscitation, artificial nutrition, hydration, and dialysis.
  • A health care power of attorney (naming an agent)Appoints a trusted person to make medical decisions on your behalf if you lose decision-making capacity. Depending on the jurisdiction, this person is known as your health care proxy, agent, surrogate, or patient advocate.

Many states combine these into a unified document called an Advance Health Care Directive. Others, like New York or Florida, handle them under distinct statutes with different rules. Your state's guide outlines the exact legal structure recognized where you live.

An advance directive speaks only when you cannot speak. As long as you can understand your options and communicate your choices, doctors consult you directly. You can amend or revoke your document at any time as long as you retain legal capacity.

How it works alongside other medical orders

An advance directive is not the only document found in an emergency record. It operates alongside other instruments, but each has a distinct purpose and authority:

  • POLST / MOLST ordersA portable medical order completed and signed by a physician, physician assistant, or nurse practitioner for patients with advanced illness or frailty. Unlike an advance directive, a POLST translates your treatment preferences into actionable medical orders that emergency medical technicians (EMTs) must follow immediately on scene.
  • Out-of-hospital DNR ordersA clinician-signed order specifically directing emergency personnel not to attempt CPR if your heart or breathing stops. In most states, EMTs cannot honor a living will directly in the field; they require an official state DNR order or bracelet.
  • Financial power of attorneyAuthorizes someone to manage bank accounts, pay bills, sell property, or handle business affairs. It conveys no authority to make medical decisions or view protected health records.
  • Last will and testamentTakes effect only after death to govern the distribution of property and estate administration. It has no bearing on medical treatment or life support decisions.

WearableDocs can host your advance directive alongside your POLST, out-of-hospital DNR, or agent contact records, keeping your entire critical health care file unified under one scannable code.

When a directive actually takes effect (The delivery rule)

Signing your document is only the first hurdle. In many states, an advance directive remains legally inert until a specific statutory trigger occurs: incapacitation is certified, and the document is physically or digitally delivered to your treating clinicians.

  • PAOHPennsylvania & OhioThe instrument is operative only after a copy is formally delivered to your attending physician. Without delivery, care teams follow default statutory consent laws.
  • CTNEConnecticut & NebraskaThe document takes effect only after it is delivered to the attending medical team and two physicians certify in writing that you lack decision-making capacity.
  • MOMissouriState statute requires a copy to be physically placed into your medical record before hospital staff have a legal duty to act on your specific instructions.
  • OROregonHealth care providers and facilities have no statutory duty to honor your treatment choices or recognize your agent until they have received a verified copy of the instrument.
  • MIMichiganYour patient advocate must sign a formal acceptance of appointment, and the document must be placed in your medical record, before they have legal standing to act.
  • TXTexasA medical power of attorney takes effect the moment it is signed, but it must be made available to your appointed agent and provided to the treating facility to guide care.

Even where state law does not make formal delivery an absolute condition of validity, a directive locked in a safe deposit box, filed at home in a drawer, or stored in a lawyer's archive cannot guide an attending ER physician at 2:00 AM. WearableDocs ensures your signed document is instantly accessible to anyone caring for you.

Signing it correctly: state execution rules

Every state sets strict formalities for executing an advance directive. Failing to follow your state's exact signing rules can invalidate the entire document, leaving your care to state-mandated family hierarchies or court-appointed guardians.

  • WVWest VirginiaRequires your signature to be both notarized and witnessed by two qualified adult witnesses.
  • WIFLWisconsin & FloridaState law requires two qualified witnesses, but does not mandate notarization.
  • MIMichiganRequires two witnesses who are not family members, heirs, or clinical caregivers. Notarization is not required.
  • PAPennsylvaniaRequires two adult witnesses, but does not disqualify family members across the board unless the witness is signing on your behalf due to physical inability.
  • CACaliforniaGives you a choice: execute your directive before a notary public, or sign it in the presence of two qualified adult witnesses subject to strict statutory restrictions.

Every state guide in our directory cites the exact statutory section, so you can confirm the execution rules directly from the enacted code.

Organ donation is governed by a separate statute

An advance directive directs your medical care while you are alive. Post-mortem organ donation is governed by an entirely separate body of law: your state's Uniform Anatomical Gift Act.

Many advance directive templates contain a small checkbox about organ donation. However, opting out on a generic medical form or taking your name off your state's donor registry does not legally prevent donation. Under the Anatomical Gift Act, removing yourself from a registry is classified as a revocation, not a refusal, and revocation leaves the decision to next-of-kin.

If you wish to bar organ procurement entirely, state law requires an executed Refusal of Anatomical Gift.

Two different legal instruments. One WearableDocs card.

Find your state's organ donation refusal rules →

51 State & Jurisdiction Guides

Select your state to review the recognized statutory forms, witness eligibility rules, disqualification lists, delivery triggers, and relevant legal citations.

Ready to make sure your medical choices are honored?

An advance directive only protects you if the emergency team can read it. Keep your signed instrument secure online and reachable in seconds from a card or wearable.

Get a plan

See pricing