If you don’t put your wishes in writing, end-of-life decisions may fall to doctors or hospital administrators.

Each state has different rules about who becomes the default decision maker (called a surrogate) if a patient doesn’t have a health care proxy that names a health care agent to make decisions for them. In many states, your next of kin can make medical decisions for you if you have not appointed a health care agent. But state law could limit the ability of your surrogate to make decisions for you. Also, some states do not have surrogacy laws. Health care decisions may be left up to your providers.

You should put your wishes in writing because:

  • If you don’t, your loved ones may have to go through a costly, time-consuming court process to get the legal right to make medical and financial decisions for you. This is called guardianship or conservatorship.
  • If no one is designated to make medical and financial decisions, family members may disagree on who should make those decisions and what they should be.
  • Someone who doesn’t know you well may be placed in charge of major treatment decisions.
  • Informal oral statements aren’t as useful as written instructions. It’s important to talk about your preferences with your doctors and family, but those conversations don’t have the same legal weight as a written advance directive. (If a person is physically unable to create a document, oral instructions—properly witnessed—will be legally honored).
  • Having something in writing can help your family make tough decisions and reassure them that they’re following your wishes at an emotional time.