Advance Directives and POLST in California: A Guide to Making Your Medical Wishes Known
Thinking about the end of life is never easy, but making decisions ahead of time can bring peace of mind—not just for you, but for your loved ones, too. In California, two important documents can help ensure your voice is heard, even if you’re unable to speak for yourself: the Advance Directive and the POLST (Physician Orders for Life-Sustaining Treatment) form.
These tools are powerful ways to express your preferences for medical care and to ease the burden on family members and healthcare providers during critical moments. In this post, we’ll walk through what each document is, how they work, and how to make sure your wishes are known and respected.
What Is an Advance Directive?
An Advance Directive is a document that allows you to express your wishes about medical care if you become unable to communicate. It typically includes two main parts:
Living Will – This outlines the kind of medical treatments you want or don’t want, such as life support, ventilators, feeding tubes, or Do-Not-Resuscitate (DNR) orders. It can also contain more personal an nuanced wishes that help your loved ones understand what quality of life means to you.
Health Care Proxy– This appoints someone you trust to advocate for the medical decisions you have lined out in your Living Will. This person cannot make medical decisions on your behalf if you’re unable to do so.
Anyone 18 or older can—and should—complete an advance directive. It's a vital step in making sure your values and choices are honored.
What Is a POLST?
The POLST (Physician Orders for Life-Sustaining Treatment) is a medical order created by a healthcare provider in consultation with the patient. Unlike an advance directive, which is more general and applies to future situations, the POLST is meant for people who are seriously ill or medically frail. It provides specific instructions for emergency and life-sustaining treatments, such as whether or not to perform CPR or use a feeding tube.
Because it’s a medical order, the POLST is followed by emergency medical personnel and hospital staff in real time. It must be signed by both the patient (or their legally authorized representative) and a healthcare provider.
Why These Documents Matter
Having an advance directive and, when appropriate, a POLST form, ensures that your medical care aligns with your values. They can prevent unwanted or unnecessary treatments, reduce confusion or conflict during medical emergencies, and offer clarity and guidance to your family when they need it most.
Key Components of an Advance Directive
Health Care Proxy:
Choose a trusted person—known as your health care proxy—who understands your values and is willing to advocate for you as your health declines. Be sure to talk with them about your preferences. This is a crucial step that many people miss.
Living Will (Instructions for Care):
Clearly state your preferences for life-sustaining treatment. This may include whether you want CPR, mechanical ventilation, artificial nutrition, or only comfort-focused care. Some people prefer more personalized and user-friendly formats like the 5 Wishes document, which addresses not just medical, but also emotional, spiritual, and legal aspects of end-of-life care. As an End-of-Life professional I advise to make the document as robust and customized as possible. These are your final wishes and your loved ones will appreciate knowing that they are carrying out your wishes.
Making Updates:
You can update or revoke your advance directive at any time. Just be sure to put any changes in writing and share updated copies with your health care proxy, family, and doctor. Ensure that all previous copies are destroyed.
Understanding the POLST Form
The POLST form is especially important for people with advanced illness, serious health conditions, a terminal diagnosis, or those who are medically fragile. Here’s how it works:
What’s on the Form:
The POLST includes specific choices about:
CPR – Should medical professionals attempt to restart your heart if it stops?
Medical Interventions – Do you want full treatment, limited interventions, or only comfort measures?
Artificial Nutrition – Would you want a feeding tube or IV fluids if you can’t eat or drink?
Signatures – The form must be signed by a healthcare provider and the patient (or their representative).
Who Should Have a POLST?
Unlike advance directives, POLST forms are not for everyone. They are intended for individuals who are seriously ill or near the end of life. If you’re healthy, you likely don’t need one yet.
Where to Keep It:
Keep your original POLST form in an accessible place—on the refrigerator, by the bedside, or in a medical file. Provide copies to your healthcare proxy, doctor, and any caregivers.
When It’s Used:
The POLST guides medical professionals in emergencies, based on your current condition. It differs from an advance directive, which is more general and used when you can’t make decisions yourself.
Can You Change a POLST?
Yes. You can revise or void your POLST at any time. Any changes must be discussed with your healthcare provider and reflected in a newly signed form.
How to Get Started
Get the Forms:
You can download California’s Advance Health Care Directive form online. The POLST form is available through your medical provider or from the California POLST website.
Have the Conversation:
Start talking with your family and doctor about your wishes. These conversations can be difficult but are incredibly important. Consider using tools like GoWish cards or Five Wishes to help guide the discussion. Some families opt to take a class or engage the help of a local End-of-Life Practitioner to ensure these documents express their wishes and take into account end-of-life variables.
Share Your Documents:
Once your forms are completed, make sure they’re shared. Give copies to your proxy, doctor, and close family. Some people choose to register their advance directive with the California Secretary of State’s Advance Directive Registry or an online health record system.
Common Questions
Does an advance directive include financial decisions?
No. You’ll need a separate financial durable power of attorney to designate someone to handle financial matters.
Can my health care proxy override my living will?
In most cases, no. Your written wishes guide your care, unless you specifically give your proxy the authority to make different decisions.
Is a POLST required?
No. It’s completely voluntary and only recommended for those who are seriously ill or frail.
What if someone doesn’t have these documents?
Without an advance directive or POLST, decisions are typically made according to California law and hospital policy—often defaulting to life-prolonging treatment without regard for quality of life.
Final Thoughts…
Taking the time to complete an advance directive is one of the most compassionate and empowering steps you can take. It helps you clarify your values, ensures your wishes are respected, and eases the decision-making burden for your loved ones.
If you haven’t started this process yet, now is a great time. Download the forms, and open the conversation with your family. Planning today can bring peace tomorrow. This can be difficult for many as our society does not openly discuss death and dying. If you are ready to start the conversation know that the peace of mind for you and your loved ones will be priceless.
Advance Directive Planning Session with a Professional Death Doula
Planning for future medical decisions doesn’t have to be overwhelming—and you don’t have to do it alone. In this one-on-one Advance Directive Planning Session, you’ll receive compassionate, expert guidance from a certified death doula who understands the emotional, legal, and medical aspects of end-of-life care.
Whether you're just starting or updating an existing directive, I’ll walk through your options together—clearly, calmly, and without judgment. You’ll leave with completed documents, peace of mind, and confidence that your wishes will be known and respected.
In this session, you will:
Learn the difference between Advance Directives, Living Wills, and POLST forms
Clarify your values and goals for medical care
Appoint a healthcare proxy who understands your wishes
Receive help completing and distributing your documents
Get access to tools like the “5 Wishes” and other planning resources
This is more than paperwork—it’s a meaningful step toward protecting your voice and easing the burden on your loved ones.
Book today and take the first step in owning your end-of-life choices—with support every step of the way.
This is hard. I can help.
