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Advance Health Care Directives

Advance health care directives

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A ccording to a Reuters article, nearly 37 percent of American adults have taken steps to have an advanced health care directive prepared. Half of all those who took steps to have an advanced health care directive prepared were not suffering from any type of chronic illness. In fact, overall, 38.2 percent of those with a chronic illness have advanced health care directives, while 32.7 percent of healthy people have an advanced health care directive.

An advanced health care directive lays out end-of-life care in the event of a serious illness or inability to make health care decisions. End-of-life care is a very personal matte, and is a conversation which has revived since January 1, 2016, when Medicare began reimbursing physicians for advance-care planning counseling.

All adults should strongly consider having an advanced health care directive because life is uncertain at best. Far too many people think advanced care planning is about old age, however, a medical crisis can leave any person, at any age, unable to make his or her own healthcare decisions. If you were to be rendered unable to speak for yourself—whether through an accident or an illness—wouldn’t you rather your own decisions were carried out instead of leaving it to chance?

Having a comprehensive advanced health care directive in place allows you to choose a person you would trust to make decisions on your behalf and can also take the burden off your loved ones in the event of an emergency or a debilitating illness. Having an advanced health care directive prepared can seem like an overwhelming task—one that can be made substantially easier with a Sonoma estate planning lawyer.

Understanding Advanced Health Care Directives

When you first begin considering an advanced health care directive, you will think about all the different types of decisions which could conceivably be necessary in the event of an unexpected accident or illness (or if you already have a chronic or degenerative illness). The legal preferences you lay out in your advanced health care directive will go into effect only if you are incapacitated and unable to speak for yourself.

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Your individual values and desires as they relate to end-of-life care will be fully expressed in your advanced health care directive. Adjustments can be made to your advanced health care directive any time there is new information, a change in your health or you want to change the person you’ve chosen to make your end-of-life decisions. Having an experienced estate planning attorney by your side can make preparation of the advanced health care directive a simple task, plus your Sonoma estate planning attorney can help you make any changes you deem necessary at any time. 

What Types of Decisions Will You Set Forth in Your Advanced Health Care Directive?

Generally speaking, you will be detailing decisions regarding the use of emergency treatments to keep you alive in the event of a tragedy, such as CPR, artificial hydration and nutrition, comfort care and the use of a ventilator. To further detail these very specific decisions, you might want to consider a Physician Order for Life-Sustaining Treatment (POLST) Form, which is a medical order for specific medical treatments you would want during a medical emergency. A POLST form is not a substitute for an advanced health care directive, rather can work in conjunction with the directive and is particularly appropriate for those with a serious illness or advanced frailty.

Where to Start


Although it can seem overwhelming to think about all the issues related to an advanced health care directive, taking it one step at a time, and having a knowledgeable Sonoma estate planning lawyer by your side can make the task immeasurably easier. Start the process by thinking about the types of medical care listed above and ask yourself whether you would want none of them, all of them, some of them, or some of them only under certain circumstances. As an example, if you are now thirty years old, and suffered an unexpected, serious auto accident which you would likely recover from with time and medical treatments, then you might want any and all medical assistance.

If, however, you are eighty-five years old and were involved in the same type of accident, your age and other medical issues might make recovery extremely difficult at best, or unlikely at worst. This means you must consider your current status in life (age, health, pre-existing conditions, etc.) when making health care decisions for your advanced health care directive.

Even if you currently have no particular health issues, and are not at a very advanced age, you might want to think about your family medical history. Have all the men in your family suffered heart attacks before the age of 60? If so, you might—or might not—make different health care decisions. You will need to carefully consider your own personal values.  Think seriously about whether you would want to have as many days of life as possible, or whether you are more concerned about quality of life.

There are no right or wrong answers, the goal is simply to define your own values regarding your life. In other words, would you be content to spend the remainder of your life on a ventilator so long as you could continue to see your family members? If you were left unable to move from a stroke, then your heart stopped, would you want CPR? If you were left mentally impaired by an accident or illness, would you want any type of life-saving measures? If you were in significant pain due to an accident or illness would you want serious pain medications which left you drowsy and unable to participate in your own life?

If you were in a coma, then developed pneumonia, would you choose to be placed on a ventilator and receive antibiotics? The answers to all these questions are very personal. Perhaps you want to stay alive as long as medically possible in order to see a grandchild born. If this were the case, then your advanced health care directive would state that any and all medical interventions be put into place on your behalf.

You might also choose to have your estate planning lawyer prepare documents which express your wishes about a single medical issue, or a specific event which is not already covered in your advanced health care directive, such as kidney dialysis or a blood transfusion. You may choose to have a DNR (do not resuscitate) in place, which will tell all medical staff that you do not want CPR or other life support measures. You might also detail your wishes for organ and tissue donation.

How to Select a Healthcare Agent

When choosing a healthcare agent—a person who will carry out your health care decisions should you become incapacitated—you will want to choose a person who, overall, shares your views regarding life and medical decisions. Your healthcare agent might be a family member, a friend, someone in your social circle or spiritual community, or your attorney. Typically, it is a good idea to also choose an alternate agent in the event your first choice is unable to step in. You will choose just how much authority your healthcare agent will have over your medical care.

You can choose to allow your healthcare agent to make the full range of medical decisions on your behalf or choose to allow your healthcare agent to make a few, very specific, medical decisions on your behalf. Always have a very frank discussion with your choice of healthcare agent before making it official. Some people simply do not want this level of responsibility, no matter how much they love and care for you.

Making Your Wishes Official

After you have carefully considered all aspects of your advanced health care directive and have discussed your decisions with your doctor, it is time to formally put those decisions and wishes into a legal document. Having an experienced estate planning attorney from the Gullotta Law Group can ensure your wishes are memorialized in a document which will be legally binding. Once your Sonoma estate planning lawyer has completed your advanced health care directive, you will want your doctor, your healthcare agent and your alternate healthcare agent to all have copies of the document.

You can tell your close family members where they can find a copy of your advanced health care directive and might even want to have one on file at your local hospital. Because you might want to make changes in the future, make sure you have a list of everyone who has a copy of your advanced health care directive so that you can exchange them when you update or make changes.

It’s a good idea to review your advanced health care directive at least every ten years, and probably more often. Changes in your life, such as marriage, a separation, a divorce, the birth of a child, the death of a spouse or a serious health diagnosis can all call for changes to your advanced health care directives. Your chosen healthcare agent or alternate agent might also change, whether due to a death or incapacitation, or simply because you have another person in mind who you believe would do a better job. Make sure you have discussed your end-of-life decisions with your loved ones so that nobody is surprised by your wishes in the event of an emergency.

The Overall Process for Your Advanced Health Care Directive

To recap, when considering an advanced health care directive you will follow this process:

  1. You will choose a medical decisions maker who will make your health care decisions on your behalf if you are too sick to make them yourself.
  2. You can give your decision maker some flexibility to determine your healthcare decisions after they have discussed the situation with a doctor, total flexibility, or no flexibility (you want your instructions to be followed to the letter, no matter the situation).
  3. You will choose certain specific health care choices you would want in the event of incapacitation.
  4. You will make decisions regarding organ donation and autopsy.
  5. You will sign the form in front of witnesses or a notary. Your witnesses must be at least 18 years old, must know you and must agree it was you who signed the form. Your witnesses cannot be your medical decision maker, your health care provider, an employee of your health care provider or an employee where you live (i.e., nursing home staff). One witness must not be related to you in any way and must not benefit financially from your death.
  6. You will share the form with family, friends and medical providers.
  7. You will ensure copies of the form are placed with your medical records everywhere you receive medical care.
  8. Should you determine later on that you want to make changes to your advanced health care directive, your attorney can help you make those changes, then ensure that the new form replaces the old one.

Getting the Help You Need from The Gullotta Law Group

The Gullotta Law Group is proud to serve the residents of Sonoma County, Santa Rosa and the surrounding communities of California with all their needs related to advanced health care directives. Our goal is to translate your specific health care wishes into a binding legal advanced health care directive. Having this document in place gives you peace of mind for whatever the future might bring.  Contact Gullotta Law Group to secure your future by setting up an advanced health care directive.

Contact Gullotta Law Group to secure your future and set up an advance health care directive! Our attorneys serve all of Sonoma County and Santa Rosa.
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