If a dire illness or injury left you unable to speak for yourself, would your loved ones know what sort of medical treatment you would want — or not want? For example, would you want a machine to breathe for you if you couldn’t breathe on your own, or a feeding tube inserted if you couldn’t eat on your own? If you’re very sick and nearing the end of your life, would you want to be resuscitated if your heart stopped beating?

Even if you’ve discussed these difficult hypotheticals, are your wishes in writing? If not, it’s time to consider creating an advance directive, a document that expresses your medical care wishes when you may not be able to so yourself.

“It’s a way of extending your autonomy beyond the time when you can speak for yourself,” says Kathleen E. Powderly, director of the John Conley Division of Medical Ethics and Humanities at the State University of New York Downstate Medical Center. Creating an advance directive isn’t complicated, but it does require careful thought.

Here’s what to consider and the steps to take.

Do it now. As tough as it to imagine, you don’t have to be old and sick to wind up unable to speak for yourself. “Anyone over 18 should consider doing an advance directive, when he or she is well and can think about what’s important,”says Powderly.

Consult your doctor. Talk to your primary care doctor about your personal health history. Discuss any particulars that may affect decisions such as being put on a respirator or fed intravenously. The conversation can help you come up with a list of preferences to include in your advance directive.

Go by the book. The rules for advance directives vary from state to state. For instance, some require that a directive be witnessed (signed) by two people over 18, neither of whom has been named as a healthcare power of attorney. “The witnesses will attest that you haven’t been coerced and that you have the mental capacity to understand what it means to delegate someone else to make your medical decisions if you’re incapacitated,” says Powderly.

The form an advance directive takes in order to be legally recognized also varies. Advance directives can be expressed through a living will and/or a durable power of attorney, a document that names who will make medical decisions for you if you can’t. Powderly advises having both, since even when your wishes are in writing they may be open to interpretation.

You can find advance directive forms by state online at sites like Caring Connections and U.S. Living Will Registry. Many forms provide decision lists so you can check off what you want or don’t want. advance health care directive                                                                      (Photo: Rallef/Shutterstock)                                             
Share copies. Once you’ve completed your advance directive, keep one copy for yourself wherever you store important papers. Give a second copy to your primary care doctor for your medical records and a third to the person you appoint as your power of attorney.

Talk through your wishes. It’s vital that you also discuss your desires with the people who will be making decisions on your behalf. According to the American Bar Association, which offers a comprehensive set of worksheets, suggestions and resources for developing an advance directive, studies have shown that standard forms have little influence without informed, thoughtful consideration on your part about what you want and communication about that with others.                                                            

In particular, “have a conversation with the person you give power of attorney to,” advises Powderly. “It can be an emotional burden but it can also provide a lot of comfort for a loved one or friend to know they’ll be doing what you want.” 

Dorothy Foltz-Gray is an award-winning health writer and author of "Make Pain Disappear" (Reader’s Digest Health Publishing) and "Alternative Treatments for Arthritis" (Arthritis Foundation).