Healthcare Directives Checklist: What to Decide First

Before any healthcare directive paperwork, a couple has six decisions to make: who would speak for each of you, who the backup is, what matters most to each of you in your own words, how detailed you want your written wishes to be, who receives copies, and when you will revisit it all. Making those decisions first — at the kitchen table, in plain language — turns the later paperwork into a short, clear conversation with an attorney instead of a confusing form-filling exercise. The binding documents themselves follow your state’s rules and belong with a licensed attorney where you live. This checklist is the thinking that comes before.

Key Takeaways

Decide people before paperwork: an agent and a backup for each partner, chosen and actually asked.
Each partner’s wishes are their own. You can make the decisions together, but the documents will speak individually.
Values come first. A few honest sentences about what matters most to you will guide every later choice — yours, your agent’s, and your attorney’s.
Decide where copies live and who holds them, or the finished documents may not be found when they are needed.
Set the review rhythm now. Decisions age, and a revisit plan keeps them honest.
This checklist prepares you for an attorney conversation; it does not replace one, and the rules for these documents vary by state.

In This Guide

Healthcare Directives in Plain English, Briefly
Decision One: Who Speaks for Each of You
Decision Two: The Backup Person
Decision Three: What Matters Most to You
Decision Four: How Detailed Your Written Wishes Should Be
Decision Five: Copies, Storage, and Who Knows
Decision Six: When You Will Revisit
The Six Decisions at a Glance
A Worked Example: One Couple Works Through the List
Taking Your Decisions to an Attorney
Frequently Asked Questions
Your Next Step
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Healthcare Directives in Plain English, Briefly

A healthcare directive is a written statement of your medical care wishes for situations where you cannot decide or communicate for yourself. Most couples meet it as two parts that often travel together: a written record of your wishes — the part many people call a living will — and the naming of a person, often called a healthcare agent or proxy, to speak for you. The umbrella term “advance directive” covers the same territory: paperwork done in advance, about care.

Two things are worth knowing before the decisions begin. First, the labels, documents, and rules are set state by state, so treat every general description — including this one — as orientation, not law. Second, these documents are one piece of a larger set of family paperwork that includes wills, guardian choices, and financial powers of attorney, all of which our pillar guide to wills, guardians, and the paperwork every parent should understand lays out together. With that picture in mind, here are the six decisions.

Decision One: Who Speaks for Each of You

Your agent is the person a care team will turn to if you cannot speak for yourself. Choose for the hard day, not the easy one. The qualities that matter are steadiness under pressure, a real understanding of what matters to you, the ability to ask questions and absorb answers in a stressful setting, and simple reachability. It is not a prize for your closest relative or your oldest friend, and it does not require any medical knowledge.

Just as important: the role has to be offered, not silently assigned. Whoever you choose deserves a conversation — what the role involves, where the document will be kept, and the broad shape of your wishes — and a genuine chance to say whether they can take it on. A reluctant agent who agreed out of guilt is a weak point in the plan, and finding that out at the kitchen table is a success, not a setback.

Each partner makes this choice separately. Spouses very often name each other, and that is a reasonable default for many couples, but it should be a decision rather than an assumption — which leads directly to the next one.

Decision Two: The Backup Person

Backups matter because life is not tidy. Your first-choice agent might be traveling, ill themselves, or unreachable in the hour they are needed — and if you and your spouse are in the same car on the same trip, a plan that names only each other has a hole in it. A backup agent is the person who steps in when the first choice cannot.

Choose the backup with the same care as the first choice, and have the same conversation with them. A backup who has never heard of the plan is barely a backup. Many couples find the backup decision easier once the first is made, because the questions — who is calm, who is near, who knows us — have already been thought through once.

Decision Three: What Matters Most to You

This is the heart of the checklist, and it is a conversation, not a form. Your agent’s job, if it ever falls to them, is to make decisions the way you would. They can only do that if they know what you value. Spend time on questions like these:

What makes a day feel like a good day to you — the things you would most want protected?
How do you think about comfort, independence, and being able to communicate with the people you love?
Are there experiences or outcomes you feel strongly about, in either direction?
How much guidance do you want to leave, and how much judgment are you happy for your agent to use?

Write down three to five honest sentences each. They do not need legal language; they need to sound like you. Notice, too, that partners often answer differently — one may prize independence above everything, the other may prize being kept comfortable and near family. Different answers are not a problem to solve. Each person’s document records that person’s wishes, and the checklist’s job is to get both sets of answers said out loud while there is time to say them calmly.

Decision Four: How Detailed Your Written Wishes Should Be

Couples approach written wishes from two directions. Some prefer broad guidance — a values statement that trusts the agent to apply it. Others prefer to think through more specific situations and record more detailed wishes. Neither pattern is automatically better. Broad guidance is flexible but leans heavily on the agent; detailed wishes say more in advance but can never cover every situation a care team might face.

Your decision here is really about your own comfort: which style would let you sleep better, and which style fits the agent you chose? This is also a decision where an attorney’s experience earns its keep — they have seen how documents like these are actually read and used where you live, and they can help translate your values into wording that works in your state’s document.

Decision Five: Copies, Storage, and Who Knows

A finished directive that nobody can find has not finished its job. Decide now: where the documents will be kept at home, in a place both partners and the agent can reach; who receives copies — most couples include the agent, the backup, and their primary care doctor’s office, which commonly asks about directives and may keep a copy with your records; and who in the wider family simply knows the documents exist, even if they never see the contents.

Decide the maintenance at the same time. Once the documents exist, a light monthly habit — checking copies, names, and changes during your regular paperwork time — keeps this decision from decaying. Our guide to making healthcare directives part of your monthly routine shows exactly how that habit works.

Decision Six: When You Will Revisit

The last decision is a date — or, more usefully, a set of triggers. Plan to revisit your choices when life changes shape: a move, especially to a new state; a marriage, divorce, or new child; the agent or backup becoming unable to serve; or a significant change in your own thinking about your wishes. Add a plain recurring rhythm on top, such as an annual look during the same season you review your other family paperwork, so the triggers are a backstop rather than the whole system.

Couples commonly stumble at exactly this stage — not on the decisions themselves, but on letting them sit unexamined for a decade, or on doing all the thinking and never booking the appointment that turns decisions into documents. Our companion article on where healthcare directives in plain English go wrong for many couples walks through those traps so you can step around them.

The Six Decisions at a Glance

Decision	What you are choosing	The conversation to have
1. Your agent	Who speaks for each partner	“Will you take this on — and do you understand what matters to me?”
2. Your backup	Who steps in if the agent cannot	The same conversation, with the same honesty
3. Your values	What matters most to each of you, in your own words	Three to five sentences each, said out loud and written down
4. Level of detail	Broad guidance, detailed wishes, or a blend	“Which style fits me — and fits the agent I chose?”
5. Copies and storage	Where documents live and who holds copies	“If this were needed tonight, who could produce it?”
6. Revisit triggers	When the decisions get reviewed	“What changes in our life should reopen this list?”

A Worked Example: One Couple Works Through the List

Meet Lisa and Mark, a fictional couple invented for this example. They set aside two evenings with the six decisions printed on a single page. The first evening went smoothly until Decision One: Mark assumed he would name his brother, then realized his brother travels constantly for work and is often out of the country — a fine brother, a risky first call in an emergency. He named a close friend who lives ten minutes away as his agent, and his brother as backup, and both men said yes when asked.

On the second evening, Decision Four surfaced a real difference: Lisa wanted detailed written wishes, Mark wanted broad values and a trusted agent’s judgment. Their resolution is the one this checklist is built to allow — each document would reflect its own person’s comfort, because the documents speak individually anyway. They left the table with a one-page decisions sheet, two different styles of wishes, and an attorney appointment booked for the following week. The paperwork conversation, when it came, took their decisions as its starting point instead of beginning from a blank form.

Taking Your Decisions to an Attorney

Bring the decisions sheet. An attorney licensed in your state will map your choices onto the documents your state uses, flag anything about your situation that deserves special attention, and handle the formalities that make the paperwork what it is. That is their role, and it is not a formality to skip: how these documents are prepared, signed, and kept is governed by rules where you live, and guessing at them is how families end up with paperwork that raises questions at the worst moment.

For general background before the appointment, USA.gov is a plain-text starting point for official state resources. And if anything in the attorney’s draft puzzles you, ask. A document you do not understand is not finished, whatever its legal status — these papers should read, to you, like the decisions you made at your own table.

Frequently Asked Questions

Do we need one directive each, or one together?

Each adult generally has their own. Your wishes, your agent, and your backup are personal choices, and they go into your own document — even when you prepare the documents at the same time, name each other, and store them in the same place. Couples decide together and document separately.

Can spouses name each other as agent?

Yes, and many do — it is often the most natural choice, since nobody knows your wishes better. The checklist point is simply to pair that choice with a backup, because the situations where a directive is needed can involve both partners at once, such as a serious car accident on a shared trip.

What if we cannot agree on each other’s wishes?

You do not have to agree, and the checklist does not ask you to. Each person’s document records that person’s wishes; your partner’s job, as agent, is to honor yours rather than substitute their own. Disagreement handled openly at the kitchen table is far easier than disagreement discovered by a care team.

How do we start the values conversation without it feeling morbid?

Keep it short and practical, and borrow the prompts in Decision Three. Many couples find it helps to treat the talk as planning rather than prophecy — the same category as insurance paperwork or writing a will. Twenty honest minutes, a few sentences written down, and you are done for the year.

Is an online form enough, or do we really need an attorney?

Whether any particular form fits your state, your family, and your wishes is a legal judgment, and it is not one to guess at on paperwork designed for a crisis. Rules and recognition vary by state. An attorney licensed where you live can say what your situation requires — that certainty is the product you are buying.

What if the person we choose says no?

Then the checklist has done its job early, when saying no costs nothing. Thank them, and move to your next choice — this is precisely why the backup decision exists and why the asking happens now rather than being assumed. A willing second choice is a stronger plan than an unwilling first one.

Your Next Step

Start with the first three decisions, tonight or this weekend. Each of you writes down a first-choice agent, a backup, and three sentences about what matters most to you. That single page — an hour at most — is most of the checklist, and it turns the remaining decisions and the attorney appointment into errands instead of a project.

This article is for general educational purposes only and is not financial, tax, legal, or investment advice. Consult a licensed professional about your situation.

Healthcare Directives in Plain English Checklist: What to Decide Before You Start