Why Advance Health Care Directives Matter – Confirming Your Voice in Medical Care Decisions

Estate planning involves more than deciding who will inherit your property. It also means protecting your ability to make choices about your own care—and giving the people you trust guidance when they need it most.

An accident, sudden illness, or medical complication can leave you incapacitated, without the ability to make essential medical care decisions. An advance health care directive allows you to identify who should make medical decisions in those circumstances and document your treatment preferences.

These documents matter at every stage of life

You do not need to be older, seriously ill, or planning a family to benefit from an advanced health care directive. Planning while you are healthy gives you time to consider your priorities, discuss your wishes, and choose someone who understands your values and will honor your preferences.

Your instructions might address life-sustaining treatment, palliative care, and/or religious and personal beliefs. Conversations with your chosen decision-maker can also help them navigate circumstances a document cannot fully anticipate. For loved ones, that guidance can ease the burden of difficult choices.

Advanced health care directives are also essential for families who need the support of a surrogate to create and grow their families. Finding another person who is willing to grow and bear your child can be an incredible gift. However, it is important to keep in mind that the health of your soon-to-be child is not the only thing to focus on. The health and wellbeing of the surrogate is also paramount – both for your child and for the surrogate and her family. As such, a key component of preparing for a surrogacy journey is to ensure that your surrogate has key estate planning documents in place, including an advance health care directive that contemplates her care and the care of the fetus she is carrying in the event she becomes incapacitated. These are difficult, but important conversations to have with family, loved ones, and mental health professionals.

Pregnancy can complicate whether your wishes are honored

For anyone who is pregnant or may become pregnant, advance health care planning raises additional questions. Would pregnancy change your preferences about life-sustaining treatment? Would your prognosis, the likelihood of a live birth, or the burdens of continued treatment affect your decision?

A 2025 Pregnancy Justice research report identified 29 states with laws overriding pregnant patients’ advance health care directives in certain circumstances. Its breakdown included 10 states imposing restrictions regardless of the likelihood of fetal survival and 19 states tying restrictions to potential fetal survival with continued treatment. Some provisions allowed exceptions or express pregnancy-specific instructions. Given the wide range of approaches taken by states in terms of compliance with a pregnant person’s advanced health care directive, it is essential to know the law where you and/or your surrogate reside and engage with an attorney well-versed in family formation law and estate planning for guidance.

A signed document should start an ongoing conversation

Remember that signing an advanced healthcare directive is just the beginning. Avoid shying away from these hard conversations and ensure that you nominate a health care decision-maker in your advanced healthcare directive that is willing to stand in on your behalf and carry out your wishes and intentions in the event you become incapacitated. Remember to get their consent to serve in this role, discuss your priorities, and make your advanced healthcare directive easily accessible.

It is also important to review your advanced health care directive from time-to-time, particularly after any significant changes in your health, relationships, or family circumstances. If you, your loved one, or the person you have engaged as a surrogate becomes pregnant, work with an attorney to ensure that advanced healthcare directives contain express language about life saving and health preserving care.

In my estate planning and assisted reproduction practice, these conversations share a common purpose: helping clients protect the people they love while preserving their own dignity, values, and voice in medical care.