What Is an Advance Health Care Directive in California, and Why Do I Need One?

Most people have strong opinions about the medical care they would want if they became seriously ill and were unable to communicate their wishes. The harder question is whether anyone else would know what those wishes are—and whether the right person would have the legal authority to speak for you.

An Advance Health Care Directive can provide that clarity. In California, an Advance Health Care Directive allows you to name a person you trust to make healthcare decisions for you if you cannot make or communicate those decisions yourself. It can also document your feelings about medical treatment and end-of-life care. At the Law Office of Georgia N. Kezios, we help clients create estate plans that address not only what happens to their property after death, but also how important personal and financial decisions should be handled during their lifetime.

What Is an Advance Health Care Directive?

An Advance Health Care Directive is a legal document that allows you to communicate your healthcare wishes and designate someone to make medical decisions on your behalf if you become unable to make those decisions yourself.

The person you designate is generally called your healthcare agent. Your agent can communicate with doctors and other healthcare providers and make decisions consistent with the instructions and wishes you have expressed in your directive.

This can become important after a serious accident, stroke, illness, or other medical emergency. It can also become relevant if a progressive condition eventually prevents you from making or communicating your own healthcare decisions.

California law recognizes an individual’s right to accept or refuse medical treatment, including life-sustaining procedures. An Advance Health Care Directive gives you a way to communicate those choices and identify the person you want involved in making healthcare decisions when you cannot speak for yourself.

Why Should You Name a Healthcare Agent?

One of the most important parts of an Advance Health Care Directive is choosing your healthcare agent.

Your agent should be someone you trust to make decisions based on your desires, rather than simply making the decisions they would personally prefer. That person may need to communicate with doctors, understand treatment options, and make difficult decisions under stressful circumstances.

For many people, a spouse or adult child is the natural choice. But there is no requirement that your healthcare agent be a family member. The most important consideration is whether the person is trustworthy, capable of communicating effectively, and willing to carry out your wishes.

It is also important to talk with the person before naming them. Your agent should understand your general preferences about medical treatment, quality of life, and end-of-life care. Having that conversation ahead of time can make difficult decisions less confusing if a medical crisis occurs.

What Can an Advance Health Care Directive Say About End-of-Life Care?

An Advance Health Care Directive can allow you to express your wishes concerning life-sustaining treatment and other medical care. The document can provide instructions that help your healthcare providers and agent understand what you would want in circumstances where you cannot make the decision yourself.

These decisions can involve issues such as artificial nutrition and hydration, life-sustaining treatment, resuscitation, and other forms of medical intervention.

You do not have to predict every possible medical situation. Instead, your directive can communicate your broader values and preferences and give your healthcare agent guidance for making decisions when circumstances arise that you did not specifically anticipate.

For many families, this is one of the most valuable parts of advance care planning. It allows you to have an important conversation about your wishes while you are healthy and able to participate.

What Is a DNR Order?

A Do Not Resuscitate (DNR) order is related to, but different from, an Advance Health Care Directive.

A DNR addresses whether cardiopulmonary resuscitation (CPR) should be attempted if a person’s heart stops beating or they stop breathing. An Advance Health Care Directive, by contrast, can address a broader range of healthcare decisions and appoint a person to make decisions when you lack capacity.

California also uses a Physician Orders for Life-Sustaining Treatment (POLST) form for people with serious illness or who are approaching the end of life. A POLST is not an Advance Health Care Directive. It is a medical order that can communicate specific treatment preferences, including choices concerning CPR and the level of medical treatment desired. California’s Department of Public Health explains that a POLST is intended for patients with serious illness or frailty and is voluntary.

Because these documents serve different purposes, an Advance Health Care Directive does not necessarily take the place of a DNR or POLST when those orders are appropriate. Discussing end-of-life wishes with your healthcare provider can help ensure that the appropriate documents are in place.

What Happens If You Do Not Have an Advance Health Care Directive?

Without an Advance Health Care Directive, you might not have clearly identified the person you want making healthcare decisions for you if you lose the ability to make those decisions yourself.

Your family may have to determine how to respond to difficult medical circumstances without knowing exactly what you would have wanted. Different family members may have different opinions about treatment, creating disagreements at a time when everyone is already under tremendous stress.

There can also be uncertainty about who should communicate with healthcare providers and make decisions. The absence of clear instructions can make an already difficult situation more complicated.

An Advance Health Care Directive cannot guarantee that your family will never disagree. What it can do is provide a clear expression of your wishes and identify the person you have chosen to speak for you.

Can an Advance Health Care Directive Help Avoid Family Disputes?

An advance health care directive can help reduce uncertainty. Consider a situation in which an adult child believes a parent would want every possible medical treatment, while another child believes the parent would not want prolonged life-sustaining treatment in certain circumstances. Without clear instructions, family members may find themselves arguing about what their parent would have wanted.

An advance directive can provide written guidance and identify the person responsible for making healthcare decisions. This does not necessarily eliminate every disagreement, but it can give the family a clear direction.

The process of creating the document can also be valuable because it encourages families to have these conversations before a crisis occurs.

When Should You Create an Advance Health Care Directive?

You do not have to wait until you are older or seriously ill to create an Advance Health Care Directive. In fact, one of the best times to establish one is while you are healthy and able to think clearly about your wishes.

A serious accident or unexpected illness can happen to anyone at any time. Having an advance directive already in place means your family does not have to start figuring out your preferences during an emergency.

It is also a good idea to review your directive periodically. Your healthcare preferences may change as you get older, your family circumstances change, or you experience a significant medical event. You may also want to change your healthcare agent if your relationship with that person changes or they become unable or unwilling to serve.

An Advance Directive Is Only One Part of an Estate Plan

Estate planning is most often associated with wills and trusts, but a complete plan should also address what happens if you become incapacitated during your lifetime.

An Advance Health Care Directive addresses medical decisions. A Durable Power of Attorney for Assets addresses financial and property matters. A revocable living trust can provide for the management of property held in the trust if you become unable to manage it yourself.

These documents serve different purposes, but together they can provide a much more complete plan for incapacity and death.

Put Your Healthcare Wishes in Writing

You may have already talked with your spouse, children, or another loved one about the kind of medical care you would want. Those conversations are valuable, but relying solely on an informal conversation can leave important questions unanswered.

An Advance Health Care Directive allows you to put your wishes in a formal legal document and name the person you trust to speak for you. It can give your family and healthcare providers clearer direction when you may be unable to provide it yourself.

Taking the time to make these decisions now can spare your loved ones from having to guess what you would have wanted later.

Talk With a California Estate Planning Attorney

An Advance Health Care Directive is an important part of planning for the unexpected. It gives you an opportunity to identify your healthcare agent, communicate your wishes about medical treatment, and provide guidance about end-of-life care before a crisis occurs.

If you do not yet have an Advance Health Care Directive, or if your existing estate plan needs to be updated, contact the Law Office of Georgia N. Kezios in Cerritos, serving Los Angeles, Orange and Riverside counties. We can help you create a comprehensive estate plan that addresses healthcare decisions, financial matters, your property, and the people you want to protect.