Modeled after time-honored statutes governing testamentary wills that provide for family and distribute one’s property after death, advance directives must comply with prescribed formalities for valid execution of the document. Directives must be signed and dated and must usually be witnessed by two people.10 States impose various restrictions on who may serve as witnesses. Most often the appointed proxy, a spouse or relative, and the health-care provider are not permitted to witness. A few states also require a notary public (eg, North Carolina)11; others allow this as an alternative to witnessing (eg, California).12 Generally, the individual can choose a spouse, adult child, sibling, close friend, or religious advisor as his or her proxy, but most states prohibit the patient’s physician or long-term care provider from serving in both roles out of concern for possible conflict of interest. Individuals are encouraged to also choose an alternate proxy, anticipating the possibility that the first choice may be unavailable, unwilling, or not able (competent) to serve when the time comes. Directives remain valid unless and until revoked by the author, such as by destruction of the document, stating the intent to revoke it, completing a new directive, or divorce. Most states provide that use of a standard form is optional, but incorporation of the “suggested” form itself into the law (eg, Minnesota)13 makes the statutory form the most recognizable and creates the impression that it is the preferred document. Adoption of a standard form by state agencies sends the same message. At the same time, the option to use other approaches so long as they comply with the requisite formalities has allowed various consumer and advocacy organizations to develop more user-friendly forms and educational materials that are widely available.14 Laws uniformly state that no one can be required to have an advance directive as a condition of receiving health care, nor can insurance companies make having or not having advance directives a condition of coverage.