Your living will only speaks when you can't — and you decide exactly when that is
The most common worry we hear about Advance Healthcare Directives is this: “If I write down that I don’t want life-prolonging treatment, will doctors stop treating me the moment something goes wrong?”
The answer is no, and understanding why is the key to understanding how a living will actually works.
The living will directive inside our Advance Healthcare Directive begins with these words: “I do not wish my life to be prolonged by medical treatment if any one or more of the following grounds apply (the ‘eligible criteria’).”
Everything turns on that word if. Your living will is conditional. It sits silently in the background — and your doctors treat you exactly as they always would — unless and until your health deteriorates to the point where one of the circumstances you have chosen actually applies. You select the grounds. You set the thresholds. Until then, it changes nothing.
The three grounds you can choose from
(a) Terminal illness
This ground is deliberately strict. All three of the following must be true: you have a terminal illness, you are in an advanced state of irreversible decline, and you are experiencing unbearable suffering that cannot be relieved in a way you would have found tolerable. A treatable setback, or a serious diagnosis with a good prognosis, does not come close to triggering it.
(b) Permanent coma or persistent vegetative state
This applies only when qualified medical practitioners have diagnosed that your unconsciousness is permanent, not a temporary coma from which recovery is possible. Your directive names the number of doctors who must confirm the diagnosis before it takes effect.
(c) Mental incapacity — with triggers you define yourself
This ground covers traumatic brain injury, dementia, Alzheimer’s disease, or any other condition causing significant irreversible mental incapacity. But a diagnosis alone is never enough. The questionnaire asks you a series of questions so that you decide which real-life moments would mean your quality of life has gone. You can choose any of the following as your triggers:
I can no longer recognise my close family members
I can no longer communicate meaningfully with the people around me
I can no longer feed myself or swallow safely
I am bedridden and unable to leave my bed without assistance
I have been diagnosed as being in the advanced stage of dementia
I have double incontinence that is not treatable
I am no longer oriented to time, place, or person
Or something else, in your own words, that for you would mean your quality of life has gone
Any one trigger you choose is enough — but only the triggers you select count.
You can include one ground, two, or all three — the grounds are alternatives, not a package. And if a ground is ever met, your directive then sets out exactly what you do and don’t want: CPR, artificial nutrition and hydration, antibiotics, life support, and pain relief are each your separate choice.
A question a client asked us recently
“If we say no to a DNR now, and in the future our health deteriorates to the point where a DNR is appropriate, can this be stated for our family’s information?”
Yes — and the directive is built for exactly this. The standalone DNR question and the living will work together. If you decline a DNR, the directive records that you have chosen not to request one at this time, and resuscitation should be attempted if clinically appropriate. But inside your living will, you can separately direct that you do not want CPR once your eligibility criteria apply. In effect: “Resuscitate me while my health is good — but not once my condition reaches the circumstances I have chosen.”
There is also a personal values statement — “Other things my family and medical team should know about me” — where you can explain your thinking in your own words. And while you have capacity, you can revoke your directive and make a new one at any time.
How this works in real life
Margaret’s directive spoke when she couldn’t
Margaret, 81, of Tauranga, made her Advance Healthcare Directive after her husband’s long final illness, which she had found distressing to watch. She chose the mental incapacity ground and selected two triggers: no longer recognising her close family, and a diagnosis of advanced-stage dementia. If either occurred, her directive said: no antibiotics for infections, no hospital transfers for life-prolonging treatment — comfort care only, at home with her whānau.
Six years later, living with advanced Alzheimer’s, Margaret no longer knew her daughters and developed pneumonia. Without a directive, her family would have faced an agonising decision in a hospital corridor — and families often split over exactly this choice. Instead, her daughter, who was also her welfare attorney under her enduring power of attorney, showed the directive to Margaret’s GP. Under Right 7(5) of the Code of Health and Disability Services Consumers’ Rights, Margaret’s clearly expressed wishes were respected. She was kept comfortable and died peacefully at home, her family around her — united, because the decision had already been made by the one person entitled to make it: Margaret herself.
Tom’s family knew exactly what he wanted
Tom, 58, an Auckland builder, completed his directive with his wife one evening two years ago — mostly, he joked, to stop her nagging. He selected the unconsciousness ground: if he was ever in a permanent coma or persistent vegetative state, confirmed by two doctors, he wanted no artificial nutrition or hydration and no extended ventilation — short-term only, so his family could be present — with medication to keep him comfortable.
Last year, Tom suffered a catastrophic stroke. After weeks without improvement, two specialists confirmed a persistent vegetative state — the precise condition, confirmed in the precise way, his directive required. The hospital team read his directive, and treatment was withdrawn in line with his stated wishes. He died with his wife and children at his bedside. His wife later told her lawyer that the document had transformed the worst weeks of her life: the question was never “What do we do?” but “We are doing what Tom asked.” Without it, she would have been left guessing — and where families disagree, these decisions can end up before the Family Court.
These stories are illustrative composites — names and details have been changed — but they reflect how advance healthcare directives operate in New Zealand.
Make your Advance Healthcare Directive
Prepare it yourself through DYOdocs for NZ$23 (one person) or NZ$46 (couple) — or have it lawyer-checked by Ross Holmes Lawyers, normally NZ$300 / NZ$600, also just NZ$23 / NZ$46 during June 2026.
Start your Advance Healthcare Directive now →
Learn more on our Advance Healthcare Directives page, or download the optional Preparation Guide (PDF) to think your answers through first.
Please note. An Advance Healthcare Directive is not a request for assisted dying, which by law cannot be made in advance. This common-law directive is valid in New Zealand, the Pacific Islands, and the Australian states other than the Australian Capital Territory, Northern Territory, South Australia and Western Australia, which require their statutory forms to be used. Your directive includes a built-in review table. We recommend reviewing it every 3 to 5 years, and whenever your health, relationships, or circumstances change significantly. While you have capacity, you can revoke it and make a new one at any time.
Every estate plan we prepare now includes an advance health care directive as standard — because it’s too important to leave out. Your directive is tailored to your values and coordinated with your will, EPAs, and other estate planning documents.
