Los Angeles Estate Planning Attorney | Law Office of Philip J. Hoskins | Advance Health Care Directive

A power of attorney for health care is a written instrument designating an agent to make health care decisions for the principal and is known as the Advance Health Care Directive in this document.

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Scope of Powers

You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. The directive provided by me lets you do either or both of these things. It also lets you express your wishes regarding your personal care, donation of organs, and the designation of your primary physician.

Part 1 of this form is a power of attorney for health care. Part 1 lets you name another individual as agent to make health care decisions for you if you become incapable of making your own decisions or if you want someone else to make those decisions for you now even though you are still capable. You may also name an alternate agent to act for you if your first choice is not willing, able, or reasonably available to make decisions for you. (Your agent may not be an operator or employee of a community care facility or a residential care facility where you are receiving care, or your supervising health care provider or employee of the health care institution where you are receiving care, unless your agent is related to you or is a co‑worker).

Unless the form you sign limits the authority of your agent, your agent may make all health care decisions for you and all decisions regarding your personal care. You do not need to limit the authority of your agent if you wish to rely on your agent for all health care decisions and personal care decisions that may have to be made. If you choose not to limit the authority of your agent, your agent will have the right to:

(a) Consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition.

(b) Select or disapprove health care providers and institutions.

(c) Approve or disapprove diagnostic tests, surgical procedures, and programs of medication.

(d) Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care, including cardiopulmonary resuscitation.

(e) Make anatomical gifts, authorize an autopsy, and direct disposition of remains.

(f) Make personal care decisions, including determining where you will live, providing meals, hiring household employees, providing transportation, handling mail, and arranging recreation and entertainment for you.

General Scope of Authority Granted

The statement of the Health Care Directive regarding the scope of authority you would be giving is as follows:

GENERAL STATEMENT OF AUTHORITY GRANTED. Subject to any limitations in this document, I hereby grant to my agent full power and authority (a) to make health care decisions for me to the same extent that I could make such decisions for myself if I had the capacity to do so, including, without limitation, decisions to provide, withhold or withdraw artificial nutrition and hydration and all other forms of health care to keep me alive; and (b) to make personal care decisions for me to the same extent that I could make those decisions for myself if I had the capacity to do so, including, without limitation, determining where I will live, providing me meals, hiring household employees, providing transportation, handling mail, and arranging recreation and entertainment for me.

When Does the Health Directive Take Effect?

You can provide either that your health directive will take effect immediately or only after your primary physician has determined that you are unable to make these decisions for yourself.

Ordinarily I recommend the latter choice as a precaution to preserve your power to make your own decisions. There may be situations where the immediate grant of power makes more sense. For example, if you are in an accident far from home, your primary physician may not be able to make the needed determination and this could delay the ability of your health surrogate to make decisions for you.

Anatomical Gifts, Autopsies, Disposal of Remains

In your Health Care Directive you can provide for what happens to your body after your death. This includes an option giving your health care surrogate the power to make gifts of your body parts (all, none, or specific parts); the power to authorize an autopsy; and the power to dispose of your remains, including giving funeral directions.

Nomination of Conservator of Person

The use of a Health Care Directive is a means of avoiding the necessity for someone to go to court on your behalf to gain the authority to make health care decisions for you. If no health care directive existed, such a person would ask the court to appoint them as conservator of your person.

Even when you have a health care directive, it sometimes happens that a well-meaning person may ask the court for appointment as your conservator if they feel the health care surrogate you named in your health care directive is either not following your instructions or is not acting on your behalf in some way. In such an event, I recommend that you nominate someone to be your conservator if the court is going to appoint one. While the court does not have to follow your nomination, it often does.

Usually you would nominate the same person that you selected as your health surrogate, but you may wish to nominate someone else. You can also name anyone who you do not wish to be able to apply to the court for appointment as your conservator or to petition the court regarding your health care directive.

Health Care Instructions

There are two primary choices of health care instructions used by most people.  You can select one of them for inclusion in your health care directive:

(a)Choice Not To Prolong Life

I do not want my life to be prolonged if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits, OR

(B) Choice To Prolong Life

I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.

Other Types of Instructions

Another commonly used instruction is:

RELIEF FROM PAIN: I direct that treatment for alleviation of pain or discomfort be provided at all times, even if it hastens my death.

Other instructions may be added to reflect your specific wishes.

Primary Physician

You will be asked to provide the name, address and telephone number of your primary physician and, if you choose, an alternate primary physician. Select the physician who is most familiar with you and your health needs.

You do not need to name a primary physician. The advantage to doing so is that it gives you the ability to name the physician who has the power for purposes of the health directive to determine whether you can make your own decisions or not. If you do not designate your primary physician, that decision may be left to a physician who is unknown to you. The disadvantage is that if you do designate the primary physician (and alternate), you would have to change your health directive if you change physicians.  Those using HMO’s without a primary physician may not even be able to make this designation.

Registering your Advance Health Care Directive

The Secretary of State maintains the Advance Health Care Directive Registry which allows a person who has executed an advance health care directive to register information regarding the directive with the Secretary of State. This information is made available upon request to the registrant's health care provider, public guardian, or legal representative. A request for information must state the need for the information.

An advance health care directive can be made a part of the Secretary of State's registry by attaching it to the Registration of Written Advance Health Care Directive filed with the Secretary of State. As an alternative to providing the written directive to the Secretary of State, its location can be indicated on the registration form.

An advance health care directive lets your physician, family, and friends know your health care preferences, including the types of special treatment you want or don't want at the end of life, your desire for diagnostic testing, surgical procedures, cardiopulmonary resuscitation and organ donation.

Once the advance health care directive has been prepared and executed, information regarding the advance health care directive may be registered with the Secretary of State by completing the Registration of Written Advance Health Care Directive. The Registration of Written Advance Health Care Directive is a voluntary filing.