Making crucial healthcare decisions can be a challenge under the best circumstances, and it’s even more daunting during a medical crisis. In California, two vital legal tools help ensure your health care preferences are followed if you become unable to speak for yourself: the Advance Healthcare Directive and the Medical Power of Attorney (also called a healthcare agent designation). These documents empower you and your loved ones, providing clarity, peace of mind, and a roadmap for honoring your values and priorities.
In this post, we’ll explore how advance healthcare directives work in California, discuss the benefits of having one in place, explain how they interact with medical powers of attorney, and touch on related documents like the POLST (Physician Orders for Life-Sustaining Treatment). Our goal is to help you understand these tools so you can make informed choices about your care and protect the people you love from uncertainty down the road.
What Is an Advance Healthcare Directive?
An advance healthcare directive (AHCD) is a legal document that allows you to express your medical treatment preferences and appoint someone you trust to make healthcare decisions if you’re ever unable to make or communicate them yourself. In California, the advance healthcare directive replaces what was previously known as a “living will” and “durable power of attorney for healthcare,” combining both elements into a single, more comprehensive form.
By drafting this document, you can specify treatments you would or would not want under certain circumstances, such as mechanical ventilation, feeding tubes, pain management, or specific surgeries. You can also name a healthcare agent (often a family member, trusted friend, or professional) who can speak to medical providers on your behalf if you cannot. This ensures that your care aligns with your personal beliefs, faith, values, and quality-of-life considerations, even when you’re not in a position to convey them directly.
Key Components of an Advance Healthcare Directive
- Healthcare Instructions:
Your directive may detail what type of interventions you would accept or refuse. For example, you might request that all measures be taken to prolong your life or, conversely, limit certain treatments that would not improve your comfort or recovery prospects. You can outline preferences for pain management, organ donation, and specific treatments related to chronic conditions. - Healthcare Agent Appointment:
By naming a healthcare agent (sometimes called a healthcare proxy), you select someone to speak on your behalf. This agent should be someone who understands and respects your values and is willing to uphold your wishes. Their job is to consult with healthcare providers, review treatment options, and make decisions that align with your instructions and overall philosophy of care. - Flexibility and Guidance:
The advance healthcare directive often includes guidance for situations you may not have explicitly anticipated. By providing an outline of your general wishes, your agent can make informed decisions even for unexpected circumstances.
Why Having an Advance Healthcare Directive Is Important
- Clarity and Control:
Without an advance healthcare directive, medical decisions may fall to family members who don’t fully understand your values or wishes. This can lead to stress, conflict, and lingering guilt. With a clear directive, your loved ones know exactly what you would want. - Reducing Stress for Loved Ones:
In times of crisis, family members already face emotional burdens. Having your wishes documented helps them feel confident they are honoring your intentions, minimizing uncertainty and disagreement. - Ensuring Quality of Life:
With an advance healthcare directive, you can shape the care you receive, focusing on comfort, dignity, and personal meaning. Whether it’s prioritizing pain management or declining invasive measures with limited benefit, you maintain a say in your own care even when you cannot speak for yourself. - Complying with California Law:
California law recognizes advance healthcare directives as the primary tool for making healthcare wishes known. Completing one ensures you’re using the proper legal framework, giving healthcare providers confidence in respecting your outlined preferences.
How Advance Healthcare Directives Work in California
In California, anyone 18 years or older and of sound mind can create an advance healthcare directive. The document must be signed by you and notarized or witnessed by two adults. Once completed, it’s essential to share copies with your agent, doctors, and potentially your attorney to ensure everyone is aware of its existence and can access it quickly if needed.
The directive remains in effect until you revoke it or create a new one. It’s a good practice to review it periodically—especially after major life changes like marriage, divorce, the birth of a child, or a new diagnosis—to ensure it still reflects your current wishes.
POLST Forms: Another Important Piece of the Puzzle
In addition to advance healthcare directives, California law also recognizes POLST (Physician Orders for Life-Sustaining Treatment) forms. POLST forms function similar to a DNR (Do Not Resuscitate) order, specifically addressing end-of-life medical treatment decisions and reflecting a patient’s current health status.
A POLST form differs from an advance healthcare directive in that it’s a medical order signed by a physician, nurse practitioner, or physician assistant. It’s intended for individuals with serious illnesses or those nearing the end of life. The form states whether you want CPR, mechanical ventilation, tube feeding, and other life-sustaining measures. Because it’s a medical order, healthcare providers must follow it, and emergency medical technicians can rely on the form to refuse treatment as stated on the POLST. In contrast, an advance healthcare directive guides decision-making but does not have the immediate authority of a medical order.
While the POLST form can be an essential complement to your advance healthcare directive, not everyone needs one. It’s typically recommended for individuals with advanced, life-limiting illnesses. If you’re unsure whether you need a POLST, discuss it with your healthcare provider and attorney.
Keeping Documents Accessible and Up-to-Date
Just like your estate plan, your advance healthcare directive and related documents should be kept somewhere secure yet accessible. Provide copies to your agent, your doctor, and trusted family members. Make sure that key individuals know where to find these documents in case of an emergency. If you’ve already created a directive but circumstances have changed—maybe you’ve moved, your health conditions have evolved, or your chosen agent is no longer the right fit—take time to update it accordingly.
Working with an Attorney
Though California provides statutory forms and guidance for advance healthcare directives, working with an experienced attorney is incredibly valuable. A knowledgeable lawyer can help ensure your directive is comprehensive, legally sound, and aligns with your broader estate planning goals. They can also help integrate your healthcare wishes with other aspects of your plan, such as wills, trusts, and financial powers of attorney, giving you a fully coordinated approach to life’s uncertainties.
Preparing an advance healthcare directive and designating a medical power of attorney gives you a voice when you might otherwise be silent. It’s about ensuring that your healthcare choices remain centered on what truly matters to you, rather than leaving them up to chance or guesswork. By understanding and utilizing these tools, and supplementing them with documents like the POLST form when appropriate, you can approach the future with greater confidence, knowing that your values and preferences will guide your care no matter what happens.
If you’re considering setting up an advance healthcare directive or have questions about medical powers of attorney, don’t hesitate to reach out. We’re here to help you navigate these complex decisions so that you and your loved ones can enjoy greater peace of mind.