An advance directive is a set of written instructions expressing how you want future health care decisions made if you are unable to make them yourself. If you can't make treatment decisions, your doctor will ask your closest available relative or friend to help decide what is best for you.
Most of the time, that works. But sometimes everyone doesn't agree about what to do. That's why it is helpful to prepare in advance what you want to happen if you can't speak for yourself.
Before You Sign
Choose which sections you wish to include, and fill in the blanks. If you want to add specific instructions in your own words, you may do so. You must be 18 or older for your advance directive to be legally binding. If you need more space, attach extra sheets and sign or initial at the bottom of each sheet.
After You Sign
Have two witnesses sign. If you are appointing a health care representative, sit down with him or her and talk about your wishes and goals for your care. Give copies to:
- Your health care representative, if you are appointing one.
- Your doctor and other health care providers, such as your hospital, home health care agency or nursing facility.
- Close family members or friends.
When you give them a copy of your advance directive, take some time to explain what it says and what your wishes are.
Frequently Asked Questions
What is an advance health care directive?
An advance health care directive (AHCD) is the best way to make sure that your health care wishes are known and considered when, for any reason, you are unable to speak for yourself. By completing an AHCD form, California law allows for the following:
- To appoint another person as your "health care agent" or "attorney-in-fact." This person has the legal authority to make health care decisions for you when you are no longer capable of doing so yourself.
- To inform the health care providers of your limits regarding treatments. For example, you may not desire to receive treatment that only prolongs the dying process if you are terminally ill. (Your health care agent or attorney-in-fact is bound by law to make decisions regarding your treatment in accordance with the limits, if any, that you have set.)
An AHCD is completely voluntary and can be revoked at any time. No one can require you to complete an AHCD before admission to any hospital or health care facility and/or deny health care insurance benefits as a result of your AHCD.
What is the difference between an advance health care directive and a living will?
The AHCD is the legally recognized format for a living will in the state of California. It replaces previously used forms such as the Natural Death Act Declaration and the Durable Power of Attorney for Health Care. The living will did not allow you to do the following:
- TO indicate specific instructions and desires rather than simply to "not receive life-sustaining treatment if you are terminally ill or permanently unconscious." The AHCD allows you to state your wishes about refusing or accepting life-sustaining treatment in any situation. This includes any situation in which you are unable to make your own health care decisions, and not just when you are "in a coma, a persistent vegetative state or terminally ill."
- TO name a person or persons to make your health care decisions for you when you are unable to do so.
What if I already have a Durable Power of Attorney for Health Care or a Natural Death Act Declaration? Is it still valid, or must I complete a new AHCD?
All valid Durable Powers of Attorney for Health Care (DPAHC) and Natural Death Act Declaration documents remain valid. Unless your DPAHC has expired, been changed or been revoked by you, it remains valid. The only exception to this is if your DPAHC was executed before 1992; these documents had an expiration date and should be replaced.
Do I need a lawyer to complete an advance health care directive?
No. You do not need a lawyer to assist you in completing an AHCD form. The only exception applies to individuals who have been involuntarily committed to a mental health facility and wish to appoint their conservator as their agent.
Whom may I appoint as my agent?
You may appoint almost any adult to be your agent. You may choose a member of your family, such as your spouse or an adult child, a friend or someone else you trust. You can also appoint one or more alternate agents in case the person you select as your health care agent is unavailable or unwilling to make a decision. (If you appoint your spouse and later get divorced, the AHCD remains valid, but your first alternate agent will become your agent.)
It is important that you talk to the people you plan to appoint to make sure they understand your wishes and agree to accept this responsibility. Your health care agent will be immune from liability so long as he or she acts in good faith.
The law prohibits you from choosing certain people to act as your agent(s). You may not choose your doctor, or a person who operates a community care facility (sometimes called a "board and care home") or a residential care facility in which you receive care. The law also prohibits you from appointing a person who works for the health facility in which you are being treated, or the community care or residential care facility in which you receive care, unless that person is related to you by blood, marriage or adoption or is a co-worker.
I want to provide more specific health care instructions than those included on this form. How do I do that?
You may write detailed instructions for your health care agent and physician(s). To do so, simply attach one or more sheets of paper to the form, write your instructions and write the number of pages you are attaching in the space provided at the end of Section 5. Sign and date the attachments at the same time you have the form witnessed or notarized.
How much authority will my health care agent have?
Only when you become unable to make your own decisions concerning your health care will your agent have the legal authority to speak for you. Your agent will be able to accept or refuse medical treatment, have access to your medical records, make decisions about the donation of your organs, authorize an autopsy and make arrangements for your body in the event of your death.
If you do not want your agent to have all or some of these decision-making powers, you may write a statement in the AHCD form specifying your wishes. Your agent cannot authorize convulsive treatment, psychosurgery, sterilization, abortion or placement in a mental health treatment facility. When you become incapacitated, your agent must make decisions that are consistent with any instructions you have written in the AHCD form or made known in other ways, such as by telling family members, friends or your doctor. If you have not made your wishes known, your agent must decide what is in your best interests, considering your personal values to the extent they are known.
Remember, your health care agent will not be held responsible for your bill, unless that person is someone who would normally be responsible for you, such as your spouse. However, unless you have made other arrangements, your agent may be responsible for costs related to the disposition of your body after you die.
What should I do with the AHCD form after I complete it?
Make sure that it has been properly signed, dated and either notarized or witnessed as instructed on the form. Keep the original in a safe place. Give copies to the people you have appointed as your agents. Send a copy to your physician(s), your insurance company, relatives and hospital(s) where you have been an inpatient. You should make a distribution list of the people and places that you have sent a copy of your AHCD to and keep it with the original document. This is important should you want to change your AHCD in any way.
What happens if I change my mind after completing an AHCD?
An AHCD can be revoked or changed at any time, either verbally or in writing. You may revoke all or part of it, including the appointed agents. You should notify everyone on your distribution list and provide him or her with your new AHCD.
Will paramedics and other emergency personnel honor my AHCD?
Yes. If they have been made aware of your AHCD before they start any resuscitative efforts, and the AHCD clearly instructs them not to start these efforts, your wishes should be respected. You may also want to complete the Do Not Resuscitate (DNR) form and obtain a Do Not Resuscitate EMS medallion.
Will my AHCD be valid in other states?
An AHCD meets California law requirements and may or may not be honored by other states. However, most states will recognize a legally executed AHCD. If you have questions in relation to other states, you should consult a lawyer, medical society or physician of that state to determine its laws in relation to your AHCD.
What should I do if I don't have an AHCD in place before I come into the hospital?
Current federal and California laws allow a patient to verbally execute an AHCD as long as you are not comatose or confused to the point that you lack decision-making capacity. Should you need to execute an AHCD, you can do so by talking with your doctor or nurse, letting him or her know your wishes and having those wishes documented in your medical record.
What if I have complaints concerning the AHCD requirements?
Should you or your family have any complaints regarding the AHCD requirements, contact the state Department of Health Care Services. Further assistance is available through Dameron Hospital's Social Services Department.