Advance Directives

Your right to make health care decisions and how you can plan now for your medical care, if you are unable to speak for yourself in the future, is important.

 

What is an Advance Health Care Directive?
An Advance Health Care Directive (AHCD) is the best way to make sure that your health care wishes are known and considered when, for any reason, you are unable to speak for yourself. By completing an Advance Health Care Directive form, California law allows for the following:
  • To appoint another person as your “attorney-in-fact.” This person has the legal authority to make health care decisions for you when you are no longer capable of doing so for yourself.
  • To inform the health care providers of your limits to receiving treatments. For example, you may not wish to receive treatment that only prolongs the dying process if you are terminally ill. Your health care agent or attorney-in-fact is bound by law to make decisions regarding your treatment in accordance with the limits, if any, that you have set.

What is the difference betweenan Advance Health Care Directive(AHCD) and a Living Will?
The AHCD is a legally recognized form of a Living Will in the state of California. It replaces previously used forms such as the Natural DeathAct Declaration and the Durable Power of Attorney for Health Care. The Living Will didnot allow you to do the following:
  • Indicate specific instructions and desires rather than simply “not receive life sustaining treatment if you’re terminally ill or permanently unconscious.” The AHCD allows you to state
    your wishes about refusing or accepting life-sustaining treatment in any situation. This includes any situation in which you are unableto make your own health care decisions and not just when “you are in a coma, a persistent vegetative state, or terminally ill.”
  • To state your desire about your health care in any situation in which you are unable to make your own decision, not simply when “you are in a coma, a persistent vegetative state, or terminally ill.”
  • To name a person or persons to make your health care decisions for you when you are unable to do so.

What if I already have a Durable Power of Attorney for Health Care or a Natural Death Act Declaration? Is it still validor must I complete a new Advance Health Care Directive?
All Durable Powers of Attorney for Health Care (DPAHC) and Natural Death Act Declarations remain valid. Unless your DPAHC has expired, has been changed or revoked by you, it remains valid. The only exception is if your DPAHC was executed before 1992. These documents had an expiration date and should be replaced.

Do I need a lawyer to complete an Advance Health Care Directive?
No, you do not need a lawyer to help you complete an AHCD form. Exceptions apply to individuals who have been involuntarily committed to a mental health facility and wish to appoint their conservator as their agent.

Who may I appoint as my agent?
You may appoint almost any adult to be your agent. You can choose a family member or someone you trust, some examples are your spouse, an adult child, a best friend, or a work associate. You may appoint one or more agents in case your first choice is unavailable or unwilling to make a decision.

The law prohibits you from choosing certain people to act as your agent or agents. You may not choose your doctor, or a person who operates or works in a community care facility, a residential care facility where you receive care or another health care facility, unless that person is related to you by blood, marriage, adoption, or is a coworker. Should you name your spouse as your first agent and later divorce, your second agent replaces that person as your first agent.

How do I provide specific healthcare instructions in addition to those included on the AHCD?
You may write detailed instructions for your physician(s) and health care agent(s) by attaching one or more sheets of paper to the form. Be sure to specify the sections where you are making additional instructions.

How much authority willmy health care agent have?
Only when you become unable to make your own decisions concerning your health care, willyour agent have the legal authority to speak for you. Your agent will be able to accept or refuse medical treatment, look at your medical records, and make decisions about the donation of your organs, authorize an autopsy, and dispose of your body in the event of your death. If you do not want your agent to have all of these decision making powers, you may write a statement in the AHCD form specifying your exact wishes. Your agent cannot authorize electroconvulsive therapy or ECT, psychosurgery, sterilization, abortion, or placement in a mental health treatment facility. Your agent must make decisions that are consistent with what you have specified in your AHCD. Your agent will not be held responsible for your bill, unless that person is someone who would normally be responsible for you, such as your spouse. However, unless you have made other arrangements, your agent may be responsible for costs related to the disposition of your body after you die.

What should I do with the AHCDform after I complete it?
Make sure it has been properly signed, dated, and notarized or witnessed as instructed on the form. Keep the original in a safe place. Give copies to the people you named as your agents. Send a copy to your doctor(s), to your insurance company, relatives, and hospital(s) where you have been an inpatient. You keep a list of all the people and places that have a copy of your AHCD. Keep that list with the original copy of the AHCD. This will help if you want to change your AHCD in any way.

What happens if I change my mind after completing an AHCD?
An AHCD can be revoked or changed at any time, either verbally or in writing. You may revoke all or part of it, including the appointed agents. You should notify everyone on your distribution list and provide him or her with your new AHCD.

Will paramedics and other emergency personnel honor my Advance Directive?
No. Outside of a hospital or nursing facility the only document that can ensure the withholding of CPR by the paramedics is the Medical Society’s form: Emergency Medical Services Pre-hospital Do Not Resuscitate (DNR) Form and Physician Orders for Life Sustaining Treatment (POLST) Form, available from:

Merced Mariposa Medical Society
2848 Park Ave # C, Merced, 95348
(209) 723-2976

A Medic Alert bracelet inscribed “Do Not Resuscitate EMS” will also meet this need.

    MedicAlert Foundation International
    2323 Colorado Avenue
    Turlock, CA 95382
    Phone 24 hrs/day - 7 days/week – (888) 633-4298

Will my AHCD be valid in other states?
An AHCD meets California law requirements, and may or may not be honored by other states; but most states will recognize a legally executed AHCD. If you have questions about other states, you should contact a lawyer, the other states’ medical society, or a physician in that state to find out the law about your AHCD.

What should I do if I don’t have an AHCD in place before I come into the hospital?
Current federal and California law allow you to verbally execute an AHCD as long as you are not comatose or confused to the point that you lack decision-making capacity. Should you need to execute an AHCD, you can do so by talking with your doctor or nurse, letting them know your wishes and having them write that in your medical record.

What if I have complaints concerning the AHCD requirements?
Should you or your family have any complaints regarding the AHCD requirements, contact:

Further assistance is available through Mercy Medical Center’s Social Services Department. For information, please call (209) 564-5000.

Note: An Advance Health Care Directive is completely voluntary. No one can require you to complete an AHCD before admission to any hospital or health care facility, and/or deny health care insurance benefits as a result of your AHCD.