Understanding Advance Directives for Healthcare

An Advance Healthcare Directive is a document that you can create to help your physicians, medical care team, family and friends know your healthcare preferences when you may not be able to speak for yourself. An Advance Directive can provide instructions for the types of medical treatment you want or don’t want, including desire for diagnostic testing options, surgical procedures, cardio-pulmonary resuscitation instructions and end of life care.

Having an Advance Directive is an important document that will help your medical providers, friends and family understand your desired healthcare treatment instructions when you may not have a voice.

Each state has its own set of regulations for an Advance Directive. We’ve provided links below to access details for an Advance Directive by state, but we’ve also laid out an example of how this works in California.

On July 1, 2000, the California Health Care Decisions Law went into effect [A.B. 891, 1999 Stat. ch. 658].  The law made extensive changes in the rules governing "advance health care directives," which allow  persons to designate how they will be cared for in the event that they later become incompetent. The law  revoked existing rules dealing with the designation of surrogates to make health care decisions on behalf  of incompetent patients, and replaced them with a new set of standards. Thus, the old durable power of  attorney for health care statute and the Natural Death Act were repealed. However, documents created  under the old laws prior to July 1, 2000 continue to be valid under the same terms on which they were  drafted [Cal. Probate Code §4665]. Documents created after July 1, 2000 must conform to the  requirements of the California Health Care Decisions Law. In addition, advance directives created in other  states under the laws of those states are valid in California [Cal. Probate Code §4676(a)]. 

The California Health Care Decisions Law identifies two types of advance directives that a competent  adult may sign to deal with future situations where he or she may be incompetent.

The first is an  "individual health care instruction," by which a person states his or her wishes concerning treatment or  non-treatment in particular named circumstances, including, possibly, end-of-life situations.

The second is  a "power of attorney," by which an individual designates an "agent" to make decisions on his or her behalf  in the event of incompetency. The California Health Care Decisions Law presents a model form entitled  "Advance Health Care Directive" that serves as both a power of attorney and an individual health care  instruction [Cal. Probate Code §4701].  

An Advance Health Care Directive is the best way to make sure that your health care wishes are known  and considered if for any reason you are unable to speak for yourself. By completing a form called an  "Advance Health Care Directive" California law allows you to do either or both of two things:  

First, you may appoint another person to be your health care "agent." This person (who may also be  known as your "attorney-in-fact") will have legal authority to make decisions about your medical care if  you become unable to make these decisions for yourself. Second, you may write down your health care  wishes in the Advance Health Care Directive form—for example, a desire not to receive treatment that  only prolongs the dying process if you are terminally ill.  

The Advance Health Care Directive is now the legally recognized format for a living will in California. It  replaces the Natural Death Act Declaration. The Advance Health Care Directive allows you to do more  than the traditional living will, which only states your desire not to receive life-sustaining treatment if you  are terminally ill or permanently unconscious. An Advance Health Care Directive allows you to state your  wishes about refusing or accepting life-sustaining treatment in any situation.  

Unlike a living will, an Advance Health Care Directive also can be used to state your desires about your  health care in any situation in which you are unable to make your own decisions, not just when you are in  a coma or are terminally ill. In addition, an Advance Health Care Directive allows you to appoint someone  you trust to speak for you when you are incapacitated. You do not need a separate living will if you have  already stated your wishes about life-sustaining treatment in an Advance Health Care Directive. 

The Advance Health Care Directive has replaced the Durable Power of Attorney for Health Care (or  "DPAHC") as the legally recognized document for appointing a health care agent in California. The  Advance Health Care Directive allows you to do more than a DPAHC. An Advance Health Care Directive  permits you not only to appoint an agent, but to give instructions about your own health care. You can  now do either or both of these things.  

Surgical Center & Hospital Policies: While all of your Advance Directive documents play an important role as to how healthcare decisions are made for patients; Medical Centers, Hospitals and Surgical Centers also have their own policies.  Many of these policies state that reasonable efforts will be made to revive the patient during an adverse event during your episode of care at the facility. If you have any planned surgical visits you should bring your Advance Directive with you so it can be placed in your medical record for reference. You should also make sure your primary care physician and any friends and family have a copy of the Advance Directive.

Additional information and resources, including sample forms, are available form the website of the Office  of the Attorney General. An example of a California Advance Directive can be found HERE.   AARP also has links to sample forms for each state and instructions of how to fill out the forms click HERE to see different Advance Directive Forms by State.