Imagine a scenario no one likes to think about: a sudden accident or serious illness leaves you unable to communicate your wishes to your doctors. Without the right legal documents in place, the people you love most may be left guessing — or worse, arguing — about what you would want. That's exactly the problem that healthcare directives are designed to prevent.
In New York estate planning, healthcare directives aren't just paperwork. They're the voice you need when you can't speak for yourself. Here's how each document works, what the legal requirements are, and why putting these pieces in place now is one of the most meaningful things you can do for your family.
The health care proxy: naming someone you trust
The foundation of New York's advance directive framework is the Health Care Proxy. Under New York Public Health Law § 2981, any competent adult (18 or older) can appoint another person — called a health care agent — to make medical decisions on their behalf if they lose the capacity to decide for themselves.
Your agent can authorize or refuse virtually any medical treatment, including decisions about life-sustaining care. The one catch: your agent's authority only activates when your attending physician determines you can no longer make decisions on your own. Until that point, you remain in full control.
According to the New York State Attorney General's office, the form must be:
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Signed and dated by you in the presence of two adult witnesses
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Witnessed by two adults (who cannot be your named agent or alternate agent)
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Not notarized — New York does not require notarization for a health care proxy
You don't need an attorney to complete the form, though it's smart to work with one, especially when coordinating the proxy with the rest of your estate plan. You can also name an alternate agent in case your first choice is unavailable.
One thing many Brooklyn families overlook: if you're a patient in a hospital or nursing home, the staff of that facility generally cannot serve as your agent unless they're a relative. That's worth knowing before you're in a hospital room trying to figure it out on the spot.
The living will: your written instructions
A living will is a written statement of your specific medical wishes — things like whether you want artificial ventilation, tube feeding, or resuscitation if you're in a terminal condition or permanently unconscious.
Here's something New York does differently from most states: there is no specific statute in New York that formally authorizes living wills. Instead, New York courts recognize them under common law, as established in the landmark 1988 Court of Appeals case Matter of Westchester County Medical Center (O'Connor). In that ruling, the court held that a person's wishes to refuse life-sustaining treatment must be proven by "clear and convincing evidence." A properly written living will is the most reliable way to meet that standard.
What does this mean practically? Vague conversations or informal requests to family members may not be enough. A written document — with specific language about the treatments you do or don't want — gives doctors and hospitals the legal footing they need to honor your choices.
New York's living will doesn't require notarization, but it should be signed in front of two adult witnesses. The New York State Attorney General provides a fillable template, and working with an experienced estate planning attorney to draft the language can prevent ambiguity that might arise in a crisis.
Why you need both — not one or the other
A health care proxy appoints a decision-maker. A living will gives that person (and your medical team) specific written guidance. Together, they cover the full picture.
Without a living will, your agent has broad discretion — which can be a lot of pressure on a family member during an emotional moment. Without a health care proxy, a living will may not have a designated person to enforce it. The documents work best as a team.
This combination is especially relevant for families concerned about long-term care. At Alatsas Law Firm, attorney Ted Alatsas regularly works with Brooklyn and Queens families to make sure these documents are tightly integrated with the broader estate plan — wills, trusts, and Medicaid asset protection strategies — so that nothing falls through the cracks when it matters most.
The MOLST form: when medical orders are needed
For individuals facing serious illness or advanced age, New York adds another layer: the Medical Orders for Life-Sustaining Treatment (MOLST). Unlike the health care proxy or living will — which are legal documents — the MOLST is an actual medical order, signed by a licensed physician, nurse practitioner, or physician assistant.
According to the New York State Department of Health, the MOLST is also the only authorized form in New York for documenting non-hospital Do Not Resuscitate (DNR) and Do Not Intubate (DNI) orders. That matters because emergency responders are legally bound to follow those orders if they're on the proper form.
MOLST forms are generally appropriate for people with a serious or life-threatening illness, not for healthy adults doing routine estate planning. Healthy individuals are better served by a health care proxy and living will. Your physician initiates the MOLST conversation based on your current medical condition — it's not something you draft on your own.
Revocation: you can always change your mind
All three of these documents are revocable. You can cancel a health care proxy at any time, simply by notifying your agent or your healthcare provider — no written form required, as long as you have capacity. The same applies to a living will. A MOLST can be voided or amended as long as you retain decision-making capacity.
The key is keeping copies accessible. Share them with your primary care doctor, any specialists, your designated agent, and close family members. Some families keep a copy with other estate planning documents and note their location in an emergency information sheet.
Bringing it all together
Healthcare directives are the part of estate planning that people tend to put off — usually because they don't like thinking about the scenarios that make these documents necessary. But they're also the part that families are most grateful for when a medical crisis hits.
A complete New York estate plan typically includes a health care proxy, a living will, a durable power of attorney, and either a last will and testament or a revocable living trust. The healthcare directives handle your medical wishes; the other documents handle your finances and your legacy.
If you're a Brooklyn, Queens, or Staten Island family who hasn't put these documents in place yet — or if you have older versions that haven't been reviewed in years — it's worth having a conversation with an attorney who knows both the legal requirements and the community you're planning for. At Alatsas Law Firm, those conversations happen every day, and they rarely take as long or feel as daunting as people expect.
