What is an Advance Directive?
An advance directive is a document that spells out your preferred health care choices should you become incapacitated. If, for instance, you suffer from high blood pressure, but you end up having a stroke and cannot make medical decisions for yourself, you can dictate treatment options in advance with a written health care directive.
In California, this is called an advance health care directive, which is created on one document that combines aspects of both a living will (the statement of your medical choices) and a medical power of attorney (naming a proxy to make decisions for you when you are unable to do so yourself). The document must be signed by two witnesses, or it must be notarized, in order to be legally binding.
What decisions should you address in your advance directive? Important decisions include:
- The use of equipment such as dialysis machines for your kidneys or ventilators to help you breathe
- The use of CPR if your heart or breathing stops — commonly referred to as a “do not resuscitate” (DNR) order if you choose not to have CPR performed
- Foods or liquids supplied through an IV or feeding tube should you be unable to eat
- Treatment for pain, suffering, nausea, or anxiety through drugs (comfort or palliative care)
- Donation of your organs after death
In California, you cannot choose euthanasia as an option, but you can specify your wishes to be taken off of life-support equipment.
The directive should be shared with family members and other concerned parties, including your named proxy. It can also be registered on a directory with the Secretary of State, where it will be accessible only by those you name, by health care providers, or by a guardian or conservator if one is named for you.
If you spend part of your time living outside of the state, you may want to check the advance directive requirements in other states to be sure you’re in compliance.
Appointing a Proxy to Make Decisions
An advance directive allows you to name someone as your agent, or proxy (also known as an “attorney-in-fact”), to make medical decisions on your behalf should you become unable to do so. You can also name alternate agents.
The person you name can be anyone you choose — a spouse, adult child, friend, or someone you trust. By law, you cannot name a doctor or a person who operates a community care facility or residential care facility, unless they are related by blood, marriage, adoption, or they are a coworker. The agent is responsible for carrying out your wishes as specified.
Though it’s technically possible to name co-agents (rather than alternates), the California Medical Association (CMA) advises against this choice since it defeats the purpose of the directive. If the co-agents disagree on a medical decision, your wishes may never be carried out. It’s safer to have one agent responsible for carrying out your decisions.
Modifying or Revoking an Advance Directive
If you change your mind on some of your decisions or wish to add new details, you can amend your directive by adding a written addendum. However, this method can sometimes result in confusing or contradictory instructions. It might be better just to revoke the document and start over.
To cancel and revoke your advance directive, you will need to create a written statement that you then sign and date in the presence of witnesses.