Living Will + Advance Directive Worksheet (Prep)
A planning worksheet to organize your end-of-life and medical wishes — healthcare agent, life-support and treatment preferences, comfort care, organ donation, and personal values — before completing a legally valid advance directive with the right forms for your state.
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LIVING WILL / ADVANCE DIRECTIVE -- PLANNING WORKSHEET *** THIS IS A PREPARATION WORKSHEET, NOT A LEGAL ADVANCE DIRECTIVE. *** Use it to organize your wishes, then complete the state-approved advance-directive / living-will form for your state (often requiring witnesses and/or a notary) and review it with an attorney and your physician. Name: Sample Person Date: May 23, 2026 HEALTHCARE AGENT (who speaks for me if I cannot) Agent: Sample Agent — (555) 010-1212 Alternate: Backup Agent — (555) 010-3434 OVERALL LIFE-SUPPORT PREFERENCE Comfort-focused SPECIFIC TREATMENTS - CPR / resuscitation: only if recovery is likely - Mechanical ventilation: short-term trial OK; not long-term - Feeding tube: not if permanently unconscious - Dialysis: discuss with my agent COMFORT / PAIN MANAGEMENT Keep me comfortable and free of pain at all times, even if it may hasten death. I prefer to be at home if possible. ORGAN / TISSUE DONATION Yes — any needed WHAT MATTERS MOST TO ME (values) Quality of life and being able to recognize loved ones matters more to me than length of life. I do not want to be kept alive by machines with no realistic hope of recovery. RELIGIOUS / SPIRITUAL WISHES Please contact my faith community; I would like relevant rites available. OTHER WISHES / NOTES Discuss any major decision with my agent and my long-time physician together. NEXT STEPS [ ] Complete my state's official advance-directive / living-will form [ ] Sign with witnesses and/or notary as my state requires [ ] Give copies to my agent, doctor, and family; keep the original safe [ ] Review after major life or health changes (Worksheet only -- signatures here do NOT create a legal directive.)
About this template
A living will and healthcare advance directive let you say, in advance, what medical care you would want if you could not speak for yourself — and who should decide on your behalf. This worksheet is deliberately a **preparation tool, not the legal document**: its job is to help you think through and write down your wishes so the eventual directive is clear and so the conversations with your family and doctor are easier. The two most important things to settle are **who your healthcare agent (proxy) is** — the person empowered to make decisions if you cannot, plus an alternate — and **what matters most to you**, because no form can anticipate every situation, and an agent who understands your values can apply them to circumstances the document never named. From there, the worksheet helps you record preferences on **life-sustaining treatment** in general (prolong life by all means, a time-limited trial, comfort-focused care, or leaving it to your agent) and on **specific interventions** people most often have views about — CPR, mechanical ventilation, artificial nutrition/feeding tubes, and dialysis — along with **comfort and pain management**, **organ/tissue donation**, and any **religious or spiritual** wishes. The crucial part is what comes after the worksheet: **a worksheet is not a legal advance directive.** To be valid, an advance directive must be completed on the **forms recognized in your state and executed the way your state requires** — typically signed with witnesses and/or a notary, and the specifics differ from state to state. Once it is properly done, **give copies to your agent, your physician, and your family**, keep the original somewhere accessible (not locked away where no one can reach it in a crisis), and revisit it after major life or health changes. Because this involves your health and legal rights, review your wishes with **your physician** and consider an **attorney**, and use your state's official resources (many state health departments and organizations publish free, valid forms).
When to use it
- Organizing your end-of-life and medical wishes before completing an official directive.
- Preparing for a conversation with your family, agent, or doctor.
- Gathering your thoughts before meeting an attorney or using a state form.
- Identifying a healthcare agent and recording your values.
What to include
- Your healthcare agent and an alternate.
- Overall life-support preference and specific treatment wishes.
- Comfort/pain management and organ-donation choices.
- Your personal values and religious/spiritual wishes.
- Next steps to make it legally valid in your state.