5 Things Your Living Will Should Never Say

A living will is only as useful as the language it contains. You might spend an afternoon thoughtfully filling one out, feeling a sense of relief that your wishes are finally on paper. But if the words you chose are vague, ambiguous, or open to interpretation, your family and doctors could end up in exactly the kind of painful disagreement you were trying to prevent.

After reviewing hundreds of advance directives and speaking with physicians, ethicists, and families who have navigated end-of-life decisions, we have identified five phrases that consistently cause the most confusion. Here is what to avoid and, more importantly, what to say instead.

1. “No heroic measures”

This is arguably the single most common — and most problematic — phrase found in living wills across the country. It sounds decisive. It feels clear. But “heroic measures” has no standard medical or legal definition.

To one physician, heroic measures might mean CPR and mechanical ventilation. To another, it could include antibiotics, dialysis, or even a feeding tube. Your family might have a completely different understanding. The result is confusion at the worst possible moment, when everyone is already under enormous emotional stress.

What to say instead: Be specific about each treatment. State whether you do or do not want CPR, mechanical ventilation, feeding tubes, dialysis, blood transfusions, and antibiotics. Address each one individually and, if possible, describe the circumstances under which your preferences might change — for example, whether you would want short-term ventilation after surgery but not long-term ventilation with no hope of recovery.

2. “I don’t want to be kept alive by machines”

Like “heroic measures,” this phrase feels powerful and clear in everyday conversation. But in a medical context, machines are involved in nearly every aspect of hospital care. Heart monitors are machines. IV pumps are machines. Even the beds that prevent bedsores use mechanical components.

When a physician reads “no machines,” they face an impossible task of figuring out which machines you meant. Did you mean only the ventilator? What about a BiPAP for temporary breathing support? What about the pump delivering pain medication?

What to say instead: Name the specific interventions. Instead of “machines,” specify your preferences for mechanical ventilation, cardiac assist devices, and dialysis machines individually. It takes a few more sentences, but it can save your family weeks of anguish.

3. “Use your best judgment”

This phrase is often directed at a healthcare agent or family member, and it comes from a place of trust and love. Unfortunately, it can become a crushing burden. When your loved one is standing in an ICU at 2 a.m. and a doctor is asking whether to start dialysis, “use your best judgment” provides no guidance at all.

Even worse, it can create conflict among family members who each believe their judgment is best. One sibling thinks Mom would have wanted everything done. Another is sure she would have wanted comfort care only. Without specific direction from you, there is no way to resolve the disagreement except through painful conflict — or sometimes even through the courts.

What to say instead: Give your healthcare agent specific instructions and describe your values in detail. You might write: “If I have no reasonable chance of recovery and cannot communicate, I prefer comfort-focused care only. I would not want CPR, ventilation, or dialysis in that situation. I would want pain management even if it might shorten my life.” You can still empower your agent to make situational decisions, but anchor those decisions in clear preferences.

4. “If there is no hope”

Hope is a deeply personal and subjective concept. Physicians deal in probabilities, not absolutes. There is almost always some statistical chance of improvement, even if that chance is one in a thousand. Saying “if there is no hope” forces everyone to agree on when hope has run out — and that is a threshold people rarely agree on.

Families have been torn apart over this question. One family member clings to a 2% chance; another considers it hopeless. Meanwhile, the medical team cannot make a definitive declaration that there is “no hope” because medicine simply does not work that way.

What to say instead: Use specific clinical scenarios. For example: “If two physicians agree that I have an irreversible condition with no reasonable expectation of recovery to a state where I can communicate and recognize family members...” This gives doctors a concrete standard to apply rather than an emotional one.

5. “I want to die with dignity”

Dignity means different things to different people. For some, dignity means being free from pain even if that means less consciousness. For others, dignity means remaining alert and engaged as long as possible, even if that means enduring some discomfort. For still others, dignity is about appearance — not wanting loved ones to see them in a diminished state.

Because the word carries so many meanings, it provides almost no actionable guidance for medical teams or family members making real-time decisions.

What to say instead: Describe what dignity looks like to you. You might write: “I value being free from pain above remaining conscious. I would prefer to be sedated rather than alert but suffering.” Or: “I want to remain as alert and engaged as possible for as long as possible, and I accept some pain as part of that.” These concrete statements give your care team something they can actually act on.

The common thread: specificity saves families

Every one of these problematic phrases shares the same flaw: they feel clear to the person writing them, but they are open to wildly different interpretations by the people who will eventually read them. And those people will be reading them during one of the most stressful, emotional periods of their lives.

The gift of a well-written living will is not just that it ensures your wishes are followed. It is that it lifts the burden of decision-making from the people you love. When your directives are specific and clear, your family does not have to guess. Your healthcare agent does not have to agonize. Your doctors can provide the care you actually wanted.

That specificity takes more time and thought upfront. But it is a gift that lasts far beyond your lifetime.