An Advanced Health Care Directive (ACHD) is designed to address the myriad of important end of life decisions. An AHCD or “advance directive” includes both an “individual health care instruction” and a power of attorney for health care (PAHC) – thus a single document joins both functions.. A “health care decision” is any decision made by you or your agent regarding your health care, including the following:
• Selection and discharge of health care providers and institutions;
• Approval or disapproval of diagnostic tests, surgical procedures, and programs of medication; and
• Directions to provide, withhold, or withdraw artificial nutrition and hydration and all other forms of health care, including cardiopulmonary resuscitation.
An ACHD typically also covers your instructions regarding an autopsy, disposition of your remains, and anatomical gifts. And it may address other matters important to you, such as the nature of any memorial celebration, who will be invited, how much money to spend on it, etc.
Because California has no statutory priority for who makes health care decisions for an incapacitated person, if there is no PAHC, the physician will usually turn to next of kin, unless there is family disagreement. This default practice may be particularly ill suited to certain people. Gays, lesbians, and other unmarried domestic partners, as well as singles, may be estranged from their family, as well as geographically and philosophically remote. Because the PAHC gives the agent access to medical records, clients who are HIV positive, or suffer from AIDS or other communicable or sexually transmitted diseases that carry a social stigma, may not want to reveal this to their family of origin. Actually, estrangement from family members is common and it is important that the right person is calling the shots (i.e., your chosen agent). In these cases, it is critical to have a PAHC that appoints a partner or a close friend as agent, and that contains custom-drafted provisions reflecting the unique circumstances. For instance, a document may direct the agent with respect to approved and unwelcome visitors to the ailing patient. Such directions may help avoid angry family conflicts in the hospital hallways. Similarly, the PAHC can restrict the right of particular relatives to challenge the acts of an agent in court, particularly if those certain individuals have opposing belief systems or hostility toward the designated agent. If the client lacks capacity to make a health care decision and a designation of a surrogate is necessary, the client’s registered domestic partner has the same authority as a spouse has to make a health care decision for his or her incapacitated spouse.