Advance Directives

Every adult needs an advance directive (AD) for health care regardless of age and health status. We never know when some kind of an event might leave us unable to speak for ourselves.

If people are not able to make or communicate decisions about their desired medical care, a previously written record of their health care wishes is invaluable.  

What they are:

Advance Directive is a generic term used for documents that traditionally include 2 parts:

  1. a living will (learn more) and
  2. the appointment of a health care agent via a durable power of attorney (learn more).  

How they work:

These documents allow you to provide instructions relating to your future health care, such as when you wish to receive medical treatment or when you wish to stop or refuse life-sustaining medical treatments and to designate an individual(s) to speak on your behalf if you cannot speak for yourself.

It is well known that Advance Directives ease the burden for  family members. They help relieve the stress and doubt associated with having to make important health care decisions on behalf of someone they care about, but without clear instructions. By making wishes known in advance, you can help guide your families and friends, who may otherwise struggle to decide the best course.  It is worth noting that many people choose a health care proxy who might be less emotionally involved as it might be easier to uphold their wishes rather than a beloved family member or spouse/partner. This might be a trusted attorney, friend or other associates.

Advance Directives are legally valid in California and one example of a form can be found here:  State of California Advance Directive.  This AD does not require an attorney nor a notary if there are 2 valid witnesses, preferably unrelated to the individual.

An advance directive can be changed or cancelled at any time.  This can be accomplished by notifying the health care agent, in writing, of the decision to do so. It is best to destroy all copies of the old AD and create a new one. Make sure to provide copies of the new document to the appropriate individuals.  It is strongly recommended that ADs be reviewed every year, re-signed and re-dated, indicating that the document continues to reflect current wishes.

Living Will

This part of the Advance Directive allows you to specify which kinds of treatment and care you desire if you are unable to speak for yourself.

A living will allows you to express your wishes about any aspect of your health care, including decisions regarding life-sustaining treatments.  Remember, it can include treatments and procedures you do or do not want. Statements regarding organ and tissue donation may also be included. The instructions provided in this portion of the form serve as evidence of the patient’s wishes.

Helpful Links:

Courtesy Compassion & Choices

Durable Power of Attorney

The second part of the Advance Directive, is often referred to as the Durable Power of Attorney for Health Care.

It provides the designation of someone who will be able to make decisions regarding health care if you are unable to speak for yourself due to illness or incapacitation. This designated  person may also be called a health care agent, proxy, surrogate or representative. This person should be informed and agree that you are naming him or her in the AD. It must be a person you know will truly go to bat for you and express exactly what your wishes are when you are not able.

Preparing this document provides the opportunity to designate  an agent to speak on your behalf and communicate your wishes if you are not able to do so yourself.  Appointing an agent and making sure the agent is aware of and understands your wishes is one of the most important things that you can do for yourself and your loved ones.  If the time comes for a decision to be made, the agent can participate in relevant discussions, weighing the pros and cons of treatment decisions based on your previously expressed wishes.  The agent can participate even if decision-making capacity is only temporarily affected. The degree of authority (how much or how little) you want this agent to have can be defined in the document. Alternate agents can also be appointed, in case the primary agent is unwilling or unable to act. Additionally, you may name individuals who specifically are NOT to participate in decision-making.

If an agent is not appointed, the law in most states provides for other decision-makers by default, usually beginning with the spouse and adult children and ending with the patient’s physician.  Physicians tend to err on the side of prolonging life so their decisions may not be consistent with the patient’s desires. In some cases, if the patient does not have an AD, a court may be required to appoint a guardian.

Advance Direcives
Advance Directives are legally valid in California and one example of a form can be found here:  State of California Advance Directive.  This AD does not require an attorney nor a notary if there are 2 valid witnesses, preferably unrelated to the individual.

Death is a challenge. It tells us not to waste time… It tells us to tell each other right now that we love each other. 

Leo Buscaglia

End of Life Choices California provides information and personal support regarding California’s End of Life Option Act and all other legal end-of-life options to the medical community and to the public.