Advance Health Care Directive

(Previously Known as the Durable Power of Attorney for Health Care)

What Is an Advance Health Care Directive (AHCD)?
Effective July 1, 2000, the Natural Death Act and the laws governing Durable Powers of Attorney for Health Care were replaced by the new Health Care Decisions Law. Under the new laws, a form called the Advance Health Care Directive (AHCD) replaces the previous Durable Power of Attorney for Health Care (DPAHC) form.

Like the DPAHC, the AHCD is not the same as a living trust or a will. Rather, under California law, the Advance Health Care Directive allows you to appoint a person to make medical decisions for you if you are unable to do so.

The person you appoint, known as your "agent," will have the legal authority to make decisions about your medical care if you are unconscious or cannot make these decisions for yourself. You appoint your agent by completing an AHCD form. This forms also allows you to write down your wishes with respect to the medical treatment which will be rendered to you. For example, you can state that you do (or do not) want "heroic measures," or other treatment which will lengthen the dying process if you are terminally ill.

Your agent is legally bound to follow your wishes, as written in your AHCD form. If you are incapacitated, your agent will have the ultimate authority to decide what treatment you will or will not receive. The agent will have access to your medical records, and he or she will decide whether to accept specific treatment, whether your organs should be donated, whether an autopsy should be conducted, and how your remains should be disposed of. Of course, you may limit your agent's authority when you complete the AHCD form.

However, under California law, your agent may not authorize convulsive treatment, psycho-surgery, sterilization or abortion, and may not have you committed to a mental institution.

If you have appointed an agent, but have not given that person clear directions as to your wishes, the agent will exercise his or her judgment when the need arises. Of course, your agent will not be responsible for paying for any treatment you receive.

Unless you include a specific end date in the form, the AHCD will be valid indefinitely. Also, if you change your mind about the AHCD after you sign it, simply retrieve and destroy all copies of the form, and complete a new form.

What Is a "Living Will?"
A "living will" typically lets you state your desire not to receive life-sustaining treatment if you are terminally ill or permanently unconscious. In California, this document is legally known as a "Natural Death Act Declaration."

An AHCD allows you to accept or reject life-sustaining treatment, to state your desires with respect to medical treatment if you are unable to make decisions for yourself (for whatever reason), and to appoint an agent to speak for you when you cannot do so yourself. A living will is much more limited and does not allow you to do any of these things.

If you have completed a AHCD form, you do not need a living will. However, most AHCD forms allow you to include a living will provision regarding life-sustaining treatment.

Is an Attorney Necessary?
No, it is not necessary to have an attorney to complete a AHCD. (The only exception to this is for persons who have been committed to a mental institution and who wish to appoint their conservator as their agent.) Any California resident who is at least 18 years old, of competent mind, and acting of his or her own free will may complete a AHCD.

Who Can I Appoint as My Agent?
You may appoint virtually any adult you trust to be your agent, including your spouse, child or friend. You may also elect an alternate who will step in on your behalf if your primary agent cannot or will not make a medical decision for you. However, you may not elect your doctor or someone who operates a community health care facility or a residential care facility to be your agent, or any employees of these facilities unless that person is your relative.

Of course, it is a good idea for you to talk it over with your proposed agents before you complete the AHCD form. This will ensure they understand your wishes and are willing to make these difficult decisions.

People occasionally want to elect more than one person to be their agent. This is not permitted (since it could easily lead to a situation in which the agents disagree on the treatment to be rendered).

Where Should I Keep the AHCD Form?
The AHCD form must be signed and dated, and either notarized or witnessed by two competent persons. Then, keep the original in a safe place and give copies to your designated agent, any alternate(s), family members, your doctor, health care provider and your medical insurance provider. Copies are as effective as the original. And be sure to bring a copy with you if you are going to be admitted to a hospital, nursing home or other health care facility.

How Can I Obtain an Advance Health Care Directive Form?
The California Medical Association sells an "Advance Health Care Directive Kit" for $5. To order, go to the CMA website. Forms are also available at most hospitals.