Living Will vs. Healthcare Power of Attorney: What’s the Difference?

If you have started researching advance care planning, you have probably encountered two terms that seem related but are not quite the same: living will and healthcare power of attorney (also known as a healthcare proxy, medical power of attorney, or durable power of attorney for healthcare). Many people assume they are interchangeable. They are not. Understanding the difference — and why you need both — is one of the most important steps in protecting yourself and your family.

What a living will does

A living will is a written document that contains your specific instructions about medical treatment you do or do not want if you become incapacitated. It speaks directly to your healthcare providers, telling them:

• Whether you want CPR if your heart stops
• Your preferences about mechanical ventilation
• Whether you want feeding tubes or artificial hydration
• Your wishes about dialysis
• Your pain management preferences
• Your feelings about organ and tissue donation

Think of a living will as your voice when you cannot speak. It provides direct instructions that your medical team can follow. However, a living will has a significant limitation: it can only address situations you anticipated. Medicine is complex, and there will always be circumstances and decisions that your living will does not specifically cover.

What a healthcare power of attorney does

A healthcare power of attorney (HCPOA) is a legal document that designates a specific person — your healthcare agent — to make medical decisions on your behalf when you cannot make them yourself. Unlike a living will, which provides specific instructions about specific treatments, a HCPOA provides a decision-maker who can respond to whatever situation arises.

Your healthcare agent’s authority typically includes:

• Consenting to or refusing any medical treatment, test, or procedure
• Choosing healthcare providers and facilities
• Accessing your medical records
• Making decisions about experimental treatments
• Authorizing pain management approaches
• Making post-death decisions about autopsy and organ donation (depending on your state)

The HCPOA is “durable,” meaning it remains in effect even when you are incapacitated. In fact, that is precisely when it activates — it gives your agent authority specifically because you can no longer exercise that authority yourself.

Key differences side by side

Why you need both

A living will without a healthcare agent leaves gaps. What happens when a medical situation arises that your living will does not address? The medical team is left to guess, the family may disagree, and the default decision often ends up being “do everything” regardless of what you might have wanted.

A healthcare agent without a living will puts an enormous burden on one person. Your agent must guess at your wishes, often under extreme pressure and with no written guidance. This can lead to guilt, family conflict, and decisions that may not align with what you would have chosen.

Together, these documents create a comprehensive safety net. Your living will provides the baseline — your clear, specific instructions for the most common end-of-life decisions. Your healthcare agent fills in the gaps, using their knowledge of your values and preferences to make decisions about situations you could not have foreseen. And when your living will does address a situation, it gives your agent the backing to say: “These are not my wishes. These are their wishes, written in their own hand.”

What happens when they conflict?

Occasionally, a healthcare agent’s decision may seem to conflict with the living will. For example, a living will might say “no ventilator,” but the patient needs temporary ventilation after a routine surgery from which they are expected to fully recover. In most states, the healthcare agent can override the living will if they genuinely believe it is what the patient would have wanted given the specific circumstances.

This is actually one of the strengths of having both documents. The living will provides the general framework. The healthcare agent applies judgment to specific circumstances. This flexibility is important because medicine is full of situations that do not fit neatly into the categories a living will might define.

To minimize potential conflicts, discuss your living will thoroughly with your healthcare agent. Explain not just your decisions but the reasoning behind them. When your agent understands your values — not just your rules — they are better equipped to make decisions that align with your intent even in unexpected circumstances.

State-by-state variations

It is worth noting that the legal framework for these documents varies significantly by state. Some states combine the living will and healthcare power of attorney into a single “advance directive” form. Others treat them as entirely separate documents. Some states have specific requirements for witnesses, notarization, or particular language.

Regardless of your state’s format, the underlying concepts remain the same: you need both written instructions (your living will) and a designated decision-maker (your healthcare agent). Whether those come in one document or two depends on your state’s laws.

Taking the next step

Start by creating your living will — it forces you to think through your treatment preferences in a structured way. Then choose your healthcare agent and have a thorough conversation with them about your values, your decisions, and your reasoning. Finally, make sure both documents are properly executed according to your state’s requirements and that copies are distributed to your agent, your physician, and your family.