Specific Advance Directives
Learn more about the advance directives used to express your wishes
To view/download a form, please click on the yellow "download PDF" button for the form you wish to download.
Health Care Proxy Form
Designates Health Care Agent
The New York Health Care Proxy Law allows you to appoint someone you trust to make health care decisions for you if you are unable to communicate or lose the ability to make decisions yourself. It is easy to complete the simple two-page health care proxy form. A lawyer is not needed and it does not have to be notarized; you just must have your signature witnessed by two people who are at least 18 years old, neither of whom is the health care agent you appointed.
The person appointed as the agent should ideally be willing to speak on your behalf, able to act on your wishes even if different from his/hers, a strong advocate who is trusted, someone who knows you well and understands what is important to you and who would be able to handle conflict if it arises. At least one alternate agent should also be named in case your first choice is unable to serve.
If you wish to designate specific treatments you would or would not want, click here [Choosing your End of Life Health Care Treatments] for a form that can be attached to your health care proxy form.
It is also fine to simply trust your health care agent to make the best decisions possible in whatever circumstances you are in, knowing your general wishes. However, if you do not want to have a feeding tube used in some circumstances, you must tell your agent that and write on the health care proxy form "My agent knows my wishes regarding artificial nutrition and hydration."
DNR Order
Do Not Resuscitate Order
A DNR is appropriate for elderly or very ill people who do not want to be revived if they stop breathing or if their heart stops beating. If you are at home rather than in a nursing home or hospital, you must have an official “Out of Hospital” DNR form, and it must be signed by a doctor.
Living Will
EXAMPLE
A living will lists the types of health care treatments you would or would not want under various circumstances. There is no official New York State form for a living will; the one provided here is just an example that can be changed to be consistent with your wishes. It is more important to name a health care agent, using the health care proxy form, than to create a living will; the living will is optional.
Some people prefer to have their health care agent make decisions based on their knowledge of their general wishes, rather than giving them a specific list of treatments they would or would not want. If you do not have anyone you can name to be your health care agent, a living will is better than nothing; but it is less likely to be honored if there is no health care agent.
MOLST Form
Medical Orders for Life-Sustaining Treatment
The MOLST form is similar to a living will. It allows you to state your wishes about certain healthcare treatments, including CPR, intubation, artificial nutrition and hydration, mechanical ventilation and antibiotics. It must be signed by a physician and may be more likely to be honored than a living will because it is a medical order. Some doctors are only willing to sign a MOLST form if you could be reasonably expected to die within a year or you live in a long-term care facility. However, the MOLST form may also be appropriate if you do not have a person to appoint as your health care agent. If you no longer have decision-making capacity, the MOLST form can be completed by your health care agent or public health law surrogate.
Updated 8/2020
Dementia Advance Directive
Advance Directive for Receiving Oral Foods and Fluids in Dementia
There are two purposes for completing an Advance Directive for Receiving Oral Food and Fluids In Dementia. The first is to document your wishes about when to stop efforts to provide assisted oral feeding because of advanced dementia. The second is to ensure that your appointed health care agent is empowered to honor those choices if you suffer from advanced dementia. Click here to see a complete description of the dementia advance directive.
Choosing Your End of Life Health Care Treatments
If you are terminally ill, you may eventually be unable to communicate your health care wishes to your doctor.
Some people want everything done to keep them alive for as long as possible; many people do not.
This form can be used to help your health care agent know what health care choices he or she should make for you. It will be a great relief to your loved ones to know your wishes, rather than having to guess what you would want. It will also give you peace of mind to know you have done everything possible to state your preferences. In addition to giving this form and your health care proxy form to your health care agent, you should also give copies to your doctors, family members, and close friends.