Health Care Proxies, Living Wills, MOLST & More: A New York Guide to Advance Directives and Guardianship

July 31, 2025
Rockland Estate Planning

When planning for the future, particularly regarding end-of-life care, it’s crucial to understand the tools available to ensure your medical wishes are respected. In New York, several legal documents—Health Care Proxy, Living Will, MOLST, Do Not Resuscitate (DNR) Orders, and the often-overlooked Preneed Guardian—serve distinct but sometimes overlapping purposes. As experienced New York estate planning attorneys, we often encounter confusion around these terms. This blog aims to clarify what each document does and how they work together to protect your healthcare decisions.

1. What Is a Health Care Proxy?

(Who makes your medical decisions if you can’t?)

A Health Care Proxy is a legal document that allows you (the “principal”) to appoint another person (the “agent”) to make medical decisions on your behalf if you lose the ability to make those decisions yourself.

Key features:

  • Recognized under New York Public Health Law Article 29-C.

  • Only takes effect when you are unable to make medical decisions.

  • Allows your agent to access medical records and communicate with healthcare providers.

  • You can specify limits or guidance for your agent’s authority.

2. What Is a Living Will?

(What treatments do you want—or not want—at the end of life?)

A Living Will is a written statement that outlines your preferences for medical treatment in situations where you’re unable to communicate and are facing a terminal condition or irreversible illness.

Key features:

  • Not governed by a specific New York statute, but recognized by courts.

  • Specifies the types of life-sustaining treatments you do or do not want (e.g., mechanical ventilation, feeding tubes).

  • Does not appoint a person to make decisions—that’s the role of the Health Care Proxy.

  • Often used alongside a Health Care Proxy for comprehensive planning.

3. What Is a MOLST?

(Turning your care preferences into doctor’s orders.)

MOLST (Medical Orders for Life-Sustaining Treatment) also known as POLST (Physician Orders for Life-Sustaining Treatment) are medical orders that translate a patient’s treatment preferences into actionable medical orders.

Key features:

  • Completed by a healthcare professional in consultation with the patient.

  • Used for patients with serious health conditions or who are nearing end-of-life.

  • Covers a wide range of medical decisions: intubation, antibiotics, artificial nutrition, and more.

  • Signed by a physician, nurse practitioner, or physician assistant.

  • Legally binding and travels across healthcare settings (home, hospital, nursing facility, etc.).

4. What Is a DNR (Do Not Resuscitate) Order?

(When you want to decline CPR in an emergency.)

A Do Not Resuscitate (DNR) order is a medical directive that instructs healthcare providers not to perform CPR (cardiopulmonary resuscitation) if your heart stops or you stop breathing.

Key features:

  • Separate from the Health Care Proxy or Living Will.

  • Can be issued in both hospital and non-hospital settings (using a Non-Hospital DNR form).

  • Must be signed by a physician.

  • Typically incorporated into a MOLST form.

5. Preneed Guardian Designation – Mental Hygiene Law § 81.17

(Who should be your legal guardian if a court ever appoints one?)

A Preneed Guardian is a person you designate in advance—before any court proceeding—to act as your legal guardian if you ever become incapacitated and need one. This is especially relevant if you do not have family or want to prevent certain people from being appointed as your guardian.

Key features:

  • Authorized under MHL § 81.17 of New York law.

  • Must be in writing, signed, and acknowledged (similar to a deed or power of attorney).

  • Can specify who should serve and who should be excluded as guardian.

  • Submitted to the court if a guardianship proceeding ever arises.

  • The court must give “due consideration” to your preference.

This designation is particularly useful when:

  • You want to name a trusted friend or relative.

  • You fear family conflict over your care or finances.

  • You have no close relatives but still want someone you trust.

  • You’re preparing a long-term care plan or Medicaid application.

How These Documents Work Together

Document Purpose Takes Effect When
Health Care Proxy Appoints a medical decision-maker Upon incapacity
Living Will Outlines end-of-life treatment preferences Upon incapacity
MOLST Medical orders based on patient’s preferences Immediately
DNR Declines CPR specifically Immediately or when incapacitated
Preneed Guardian Designates future legal guardian Only if court deems one necessary

Together, these tools form a comprehensive advance care plan that ensures your wishes are respected across all settings—from hospitals to nursing homes to your own home.

Why Every New Yorker Should Have These Documents

In New York, without a Health Care Proxy or Living Will, decisions may fall to a court-appointed guardian or next of kin under the Family Health Care Decisions Act—potentially delaying or complicating critical medical decisions. By proactively completing these documents, you maintain control and reduce stress for your loved ones.

Need Help With Advance Directives in New York?

Our law firm assists individuals and families across New York State in preparing customized advance directives, including Health Care Proxies, Living Wills, and more. If you have questions or need help navigating these important documents, contact us today for a consultation.

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