Have you drafted your advance medical directive (AMD)? If the answer is no, now is the time to do so. You cannot be prepared for future medical care decisions without one.

[Related: What is An Advance Medical Directive?]

Here are six important tips for how to write an advance medical directive:

1. Know your options.

Writing an advance medical directive is more than picking someone to make medical decisions for you. You need to decide what you want to happen if you cannot make care choices for yourself. However, you can’t make decisions ahead of time unless you understand what options are available to you. Before writing an advance medical directive, one of the key questions to ask yourself is:

How much medical intervention do I want, and when do I want to die a natural death?

Medical Intervention vs. Natural Death

Medical intervention means that physicians will try to keep you alive when your body would otherwise die on its own. Natural death means that physicians will make you comfortable and allow your body to shut down. Most people want medical intervention when there is a good chance they will survive and regain quality of life. Conversely, most don’t want medical intervention if their quality of life will be poor or it is unlikely they will survive.

Your specific circumstances will influence this deeply personal decision, and there is no right or wrong answer. For example, medical intervention makes more sense for a 48-year-old who has a heart attack than for a 98-year-old with terminal cancer. Take time to evaluate this question based on your age, health conditions, and personal convictions.

2. Understand the limits of an AMD.

An AMD has legal limits. The most important limit is that an AMD (at least in Virginia) cannot include a Do-Not-Resuscitate order (DNR). A DNR order must be issued and signed by a physician as a separate document. This order is also sometimes referred to as a Physician’s Order Limiting Treatment (POLST or POST).

Another limit of an AMD has to do with non-medical treatment. Many people include their non-medical wishes in an AMD, such as the people or things they want with them as they die, or the type of funeral they want to have. One popular form of an AMD called Five Wishes encourages people to specify these details.

While you can include these details in your AMD so that people know your wishes, they are not legally enforceable.

3. Communicate your wishes clearly.

Once you know what medical care you want, clearly communicate your wishes in an AMD. If you do not clearly state your wishes ahead of time, decisions will be made for you by a family member or physician. If it is a physician, important decisions about your care, treatment, and maybe whether you live or die will be made by someone who does not know you. If it is a family member, they will have to make difficult, emotional decisions without knowing your wishes. This puts them in a stressful and unfair position.

The following are those who must be able to understand your AMD:

  • your medical agent;
  • your family;
  • your physicians and the medical community; and
  • a local judge (in the event there is a dispute).

Make sure your AMD is written in a way that is clear and understandable to all of these people.

4. Choose your medical agent carefully and empower them to act.

Once you know what you want, appoint a medical agent and empower them to make decisions for you. This takes forethought and insight. Do not assume that the person you are emotionally closest to is the right choice. Choose someone who will embrace their role and advocate for you, no matter your decision. This is a mental and emotional burden that some people are not equipped to carry. You need someone who is ethical, level-headed, and not easily swayed. You should be confident your agent will be able to make hard choices on your behalf.

After choosing your medical agent, make sure to ask them—do not assign this role to someone without telling them. Do not assume they are willing to do it. Explain to them your wishes, help them understand your thinking, and prepare them as much as possible for what they may need to do. Consider having them speak with your attorney for guidance on how to implement your AMD. By taking these steps, you empower and prepare them for the future.

[Related: Who Should I Choose as My Agent?]

5. Work with an experienced attorney in your state.

For it to be effective, your AMD must comply with all the legal requirements in your state. And, as mentioned above, it is vital that your AMD is legally, medically, and personally clear. We strongly recommend that you find an experienced estate planning attorney in your area to help you create a clear, valid AMD.

6. Create your advance medical directive now.

Too many people find themselves in unfortunate situations because they don’t have an AMD.  Some of these people knew they needed one, some meant to create one but didn’t, and others thought they had more time before they would need one. Don’t make these mistakes. Create your advance medical directive now, before you are in a crisis.


Do you need more advice on how to write an advance medical directive? Schedule an appointment today. We’d love to help you create one!


Joshua E. Hummer, Esq. is a licensed attorney who has been admitted in both Virginia and West Virginia. He is a graduate of the University of Virginia and has been practicing for over 15 years. While experienced in many parts of the law, Josh specializes in estate planning, estate administration, and elder law.