What Is An Advance Health Care Directive (AHCD)?

It is a written document that specifies what type of medical care you want should you become incapacitated and cannot make those decisions.  It also allows you to name a person who you want to make decisions for you, should you lose the ability to make decisions for yourself. You must be at least 18 years old and of sound mind to make an AHCD. California requires two witnesses to witness your signature.


The Need For An AHCD.  An AHCD becomes important in cases where you would be in a condition where you could not communicate your health care choices. Having a directive provides assurance that your personal wishes concerning medical and mental treatment will be honored at a time when you are not able to express them. Another advantage is that it can be helpful when there are conflicting opinions among relatives as to what should be done. Further, it may also prevent the need for a costly and time-consuming conservatorship imposed through the California probate court.


Choosing An Agent.  This is one of the most important decisions to be made while making a health care directive. Your agent can be given powers to make those personal care decisions you normally make for yourself. Therefore, your agent should be someone close to and trusted by you. The person you choose should be one who will regardless of their feelings or beliefs will honor your wishes and carry out the instructions you provided in your AHCD.  People often choose their spouse or other close family member to be their agent. You can also limit your agent’s authority if you choose to do so. Generally, an agent will not be legally or financially liable for decisions made as long as they are in accordance with the individual’s wishes and beliefs.


Different Types Of Healthcare Directives.  Directives vary based on state law and individual preferences within the states’ legal requirements. The three most common types of healthcare directives are the durable power of attorney for health care, living will and do-not-resuscitate order/declaration. 


Power Of Attorney For Health Care.  This allows you, the Principal to appoint an Agent to make health care decisions in the event you become incapacitated. This document names the person you want to make decisions for you and provides them with guidelines for making those decisions. The Agent appointed can make decisions in accordance with what you would have wanted. However, if you specified your wishes clearly, they must be followed despite objections from your Agent.  


Living Will.  This document allows you to explain in writing which medical treatment you do or don’t want during a terminal illness.  Its purpose is to allow you to make decisions about life support and direct others to implement your desires in that regard. A living will takes effect only when you are incapacitated and can no longer express your wishes. A living will can be very specific or very general.  California combines a living will and health care power of attorney and is called an Advance Health Care Directive.


Do Not Resuscitate Order (DNR). This is a legal document that gives 911 responders permission not to perform CPR. The DNR form is prepared in advance of any situation and kept at home. It lists the name of the person to whom it applies and is signed by them. It is also signed by the person's doctor and is not valid until the doctor signs it, as it is a medical order. The DNR is the only form that affects 911 responders; other documents, such as a Power of Attorney for Health Care or Advance Health Care Directive, do not. If emergency personnel arrive to find a person whose heartbeat and breathing have failed or are failing, they will perform CPR unless they see a correctly completed DNR.  When 911 responders see this form, they will still do anything they can to make the sick person comfortable, but they will not perform CPR. In the absence of a DNR they must do CPR.  


California Probate Code §§4700-4701

4700. The form provided in §4701 may, but need not, be used to create an AHCD. The other sections of this division govern the effect of the form or any other writing used to create an AHCD. An individual may complete or modify all or any part of the form in §4701.


4701. 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. This form lets you do either or both of these things. It also lets you express your wishes regarding donation of organs and the designation of your primary physician. If you use this form, you may complete or modify all or any part of it. You are free to use a different form.  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 your or is a coworker.)  Unless the form you sign limits the authority of your agent, your agent may make all health care decisions for you.  This form has a place for you to limit the authority of your agent. You need not limit the authority of your agent if you wish to rely on your agent for all health 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 discharge 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 healthcare,          including cardiopulmonary resuscitation.

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


Part 2 of this form lets you give specific instructions about any aspect of your health care, whether or not you appoint an agent. Choices are provided for you to express your wishes regarding the provision, withholding, or withdrawal of treatment to keep you alive, as well as the provision of pain relief. Space is also provided for you to add to the choices you have made or for you to write out any additional wishes. If you are satisfied to allow your agent to determine what is best for you in making end-of-life decisions, you need not fill out Part 2 of this form. 


Part 3 of this form lets you express an intention to donate your bodily organs and tissues following your death. 


Part 4 of this form lets you designate a physician to have primary responsibility for your health care.  After completing this form, sign and date the form at the end. The form must be signed by 2 qualified witnesses or acknowledged before a notary public. Give a copy of the signed and completed form to your doctor, to any other health care providers you may have, to any health care institution at which you are receiving care, and to any health care agents you have named. You should talk to the person you have named as agent to make sure that he/she understands your wishes and is willing to take the responsibility. You have the right to revoke this AHCD or replace this form at any time.

 Afsar Estate Planning provides an AHCD for each Clients' Estate Plan