Advance Medical Directive

The witness restrictions: not the patient's health care provider or their employee, not the operator or employee of a community care or residential care facility, not the appointed agent, and at least one witness who is…

California: a written directive is dated and signed by the patient, or in the patient's name by another adult in the patient's presence and at the patient's direction.

What an ADVANCE HEALTH CARE DIRECTIVE is in California: either an individual health care instruction or a power of attorney for health care, or both in one document. California combines the two instruments;

How a directive is revoked, including that the designation of an agent may be revoked only in a signed writing or by personally informing the supervising health care provider.

CALIFORNIA'S STATUTORY ADVANCE HEALTH CARE DIRECTIVE FORM, covering appointment of an agent, individual instructions about end-of-life care, organ donation and designation of a primary physician. Start from it;

A patient in a SKILLED NURSING FACILITY must additionally have the directive witnessed by a PATIENT ADVOCATE OR OMBUDSMAN. Easy to miss and it invalidates the document; ask where the client will sign.

The designation of a spouse as health care agent is revoked on dissolution, annulment or legal separation unless the directive says otherwise.

What happens where there is no agent, surrogate or conservator. California has no statutory next-of-kin priority list of the kind Delaware and Texas use, which is the strongest argument for signing a directive here.

A patient may designate a SURROGATE orally to a supervising health care provider, effective for the period the section allows. Useful to know when a client is already hospitalised and cannot execute a directive.

THE FORM TO USE. One document carrying health care instructions, the appointment of a health care representative, the designation of a conservator for future incapacity, and an anatomical gift.

How a living will or appointment is proved and the physician's role in determining incapacity. Background to when the document actually operates.

The statutory form for health care instructions, the living will half of a Connecticut directive. Section 19a-575a's combined form is usually the better starting point because it also appoints a representative.

The standalone statutory form for appointing a health care representative, for a client who wants only the appointment and not the full combined document.

It becomes operative only when the document is FURNISHED to the attending physician or APRN AND the declarant is determined by them to be incapacitated. A signed directive in a drawer does nothing.

How earlier advance directives, appointments of a health care agent and powers of attorney for health care remain valid. Check before telling a client their older document is worthless.

A directive executed in another state or country is given effect as the section provides. Relevant for a client who moved to Connecticut.

Connecticut's MOLST programme. Like a DNR, a MOLST is a MEDICAL ORDER signed by a clinician, not a directive the client executes alone, and it works alongside the advance directive rather than replacing it.

Connecticut: a person eighteen or older appoints a representative using a document under section 19a-575a or 19a-577, signed and dated in the presence of two adult witnesses who also sign.

Appointing a spouse as health care representative is AUTOMATICALLY REVOKED on divorce, legal separation, annulment or dissolution, unless the principal specifies otherwise.

Co-agents and alternates. Name an alternate: a directive with a single agent fails exactly when the agent is unavailable.

The instruction half of a Delaware directive: the client's own directions about treatment. Read with the optional form in section 2511.

Delaware: section 2508 requires the health care power to be in a record signed by the individual and an adult witness.

The OPTIONAL STATUTORY FORM, covering appointment of an agent, treatment wishes and organ donation, with its own plain-language instructions. Start from this form;

What the agent or surrogate may decide, subject to any limits in the directive. Read with section 2519's limitations before promising a client what their agent can do.

The provider's duties on receiving a directive, including recording it and complying or transferring. Encourage the client to give a copy to their physician while well.

Names Delaware's Health-Care Decisions Act, which governs advance directives here.

The Act's defined terms, including advance health-care directive, agent, health-care instruction and surrogate. Delaware combines the instruction and the appointment into one ADVANCE HEALTH-CARE DIRECTIVE;

Delaware's capacity standard, expressed in terms of the ability to communicate a decision with reasonable accommodation and to understand the nature and consequences of the decision or instruction.

Where there is no agent or guardian reasonably available, a DEFAULT SURROGATE from the statutory priority list may decide. This is what a client gets by doing nothing;

Allows the donor, the donor's health-care agent unless restricted, a parent of an unemancipated minor, or the donor's legal guardian to make an anatomical gift during the donor's lifetime.

A gift may be made via driver's license or ID designation, a will (effective at death regardless of probate status), donor-card or registry enrollment, or, for a terminally ill donor, oral communication to two adults…

District of Columbia: section 21-2205 requires a dated health care power signed by the principal and two adult witnesses who affirm sound mind and freedom from duress.

Provides an optional statutory form for the health-care power of attorney, requiring the principal's signature, two witnesses who personally know the principal and attest to capacity and absence of duress, and at least…

Where there is no health-care power of attorney, sets a priority list for who may give substituted consent: court-appointed guardian or conservator, then spouse or domestic partner, adult child, parent, adult sibling,…

Requires the natural death declaration to be signed and dated, with two or more witnesses at least 18 years old, disqualifying relatives, estate beneficiaries, those financially responsible for the declarant's care, the…

Defines terms for the Health-Care Decisions chapter, including attorney in fact as the person receiving health-care decision authority, incapacitated individual, and durable power of attorney for health care as…

Gives the health-care attorney in fact authority to consent to, refuse, or withdraw treatment, access records, and make provider and facility decisions, requiring the agent to follow the principal's expressed wishes or,…

A principal may revoke the attorney in fact's appointment by oral or written notice, and the health-care POA is automatically revoked by dissolution, annulment, or termination of the principal's marriage or domestic…

Defines the Natural Death Act terms: a declaration is a witnessed document executed under § 7-622, a life-sustaining procedure excludes comfort care or pain management, and a qualified patient has executed a declaration…

A Florida LIVING WILL must be signed by the principal in the presence of TWO SUBSCRIBING WITNESSES, AND ONE OF THEM MAY BE NEITHER A SPOUSE NOR A BLOOD RELATIVE.

The suggested living will form, with initial lines for the terminal condition, end-stage condition and persistent vegetative state triggers.

Supervised electronic witnessing, including identity and location, questions and notices, vulnerable-adult restrictions and statutory exceptions.

Florida: a surrogate designation under section 765.202 is signed in the presence of two subscribing adult witnesses; a principal unable to sign may direct another to sign in the witnesses' presence.

The suggested statutory form for designating a health care surrogate. A good starting point; it is suggested rather than mandatory.

A parent may designate a health care surrogate for a MINOR CHILD, which is a distinct Florida instrument. Raise it with any client who has children and travels or leaves them with caregivers.

How the living will operates once the physician determines the triggering condition. The document must reach the physician to do anything.

Florida online-notary identity, location, recording, provider and certificate procedures. Subsection (9) addresses the effect of noncompliance;

The advance directive chapter's defined terms, including health care surrogate, end-stage condition, persistent vegetative state and terminal condition. Those three conditions are the triggers for a living will;

How an advance directive is amended or revoked, including by a later directive or by physical act. Capacity is not the barrier clients expect.

The Department, with the Maryland Institute for Emergency Medical Services Systems and the State Board of Physicians, maintains the MOLST form, and the listed facilities (assisted living, home health, hospice, hospital,…

The section sets out Maryland's optional advance directive form in full: Part A appointing a health care agent with the scope and effective time of the agent's authority, Part B the living-will treatment preferences…

Maryland: the ordinary written or electronic directive is dated, signed by or at the declarant's express direction, and subscribed by two witnesses in the declarant's physical or electronic presence.

An advance directive may be revoked at any time by a signed and dated written or electronic document, by physical cancellation or destruction, by an oral statement to a health care practitioner, or by executing a later…

Before treatment authorized under this subtitle is provided, withheld or withdrawn, the attending physician and a second physician or nurse practitioner must certify in writing, on personal examination, that the patient…

An adult, an emancipated minor or a minor at least 15 years and 9 months old (confirm the current figure), an agent unless a power of attorney or other record prohibits it, A PARENT ONLY IF THE DONOR IS AN UNEMANCIPATED…

A gift may be amended or revoked by a later signed record, destruction of the document with intent, an oral statement during terminal illness, ordinary will amendment for a will-based gift, or written notice to the…

Defines advance directive to include a witnessed written or electronic document, a witnessed oral statement and, in limited circumstances, an unwitnessed electronic video record, along with health care agent, surrogate,…

Where a patient certified incapable has appointed no agent, or the agent is unavailable as the section defines that term, decisions pass down a ranked list beginning with a court-appointed guardian, then the spouse or…

A Maryland notary located in the State may notarise for a remotely located individual using communication technology if the notary has personal knowledge or satisfactory evidence of identity, the technology meets the…

Massachusetts: a competent adult's written health care proxy is signed by the adult or at the adult's direction in the presence of two other adults who subscribe as witnesses under chapter 201D, section 2.

Who may serve as health care agent, with the section's limits on operators, administrators and employees of facilities where the principal is a patient or resident, unless related to the principal.

The agent may make any health care decision the principal could make, subject to any limits stated in the proxy and to the section's rules on life-sustaining treatment.

The agent's authority BEGINS only when the attending physician determines in writing that the principal lacks capacity, and ENDS if capacity returns.

Immunity for providers and agents acting in good faith under the chapter. Background that explains the paperwork providers ask for.

The health care proxy chapter's defined terms, including health care agent, health care decision and attending physician. Massachusetts says HEALTH CARE PROXY and HEALTH CARE AGENT; use its vocabulary.

A proxy executed in another state is enforceable here on the section's terms. Relevant for a client who moved to Massachusetts.

What happens where a physician declines to honour the proxy, including the duty to transfer. Encourage the client to discuss the proxy with their physician while well.

What the chapter does and does not say about a patient with no proxy. This is the default a client gets by doing nothing, and in Massachusetts it is thinner than in states with a statutory surrogate list, which is the…

The court route for disputes about a proxy or an agent's decisions. The forum when a family disagrees.

A psychiatric advance directive must be signed and dated by the declarant and witnessed by an adult attesting that the declarant is of sound mind and free of duress, and the designated mental health representative and…

An advance directive becomes operative only when it has been transmitted to the attending physician or the health care institution and it has been determined under 26:2H-60 that the patient lacks capacity to make the…

New Jersey: date and sign the advance directive by or at the direction of the declarant.

The absence of an advance directive creates no presumption about a patient's wishes regarding the provision, withholding or withdrawing of any form of health care, and the act does not apply to a person who has not…

Department of Health guidance and links to proxy and instruction directives. The page states its last review date; compare its guidance with the statutes and current clinical circumstances.

Professionals and institutions must treat the patient consistently with a completed POLST signed by the patient or representative and by the attending physician, advanced practice nurse or physician assistant, and an…

The attending physician determines whether the patient lacks capacity for a particular health care decision, must state that determination in writing with an opinion on the nature, cause, extent and probable duration of…

Once it is determined that the patient lacks decision making capacity, the health care representative has authority to make health care decisions, acting in good faith and within the bounds of the directive and the act,…

The attending physician, the health care representative and any additional physician responsible for the patient's care must discuss the nature and consequences of the patient's condition and the risks, benefits and…

Institutions must ask about and document an advance directive, and a religiously affiliated institution that will not honor a decision to withhold or withdraw treatment must take reasonable steps to transfer the…

MOLST is a physician order set, valid in all settings including by emergency medical services, that translates a seriously ill patient's wishes into actionable orders about resuscitation, intubation, hospitalisation and…

New York: the principal dates and signs the proxy in the presence of two adult witnesses, who also sign and state that execution appeared willing and free of duress.

The agent's authority begins when the attending practitioner determines to a reasonable degree of medical certainty that the principal lacks capacity, records the determination and its cause, extent and probable…

The State's MOLST form, a physician or nurse practitioner order set covering cardiopulmonary resuscitation, intubation, hospitalization, artificially administered nutrition and antibiotics, with the consent section that…

The agent may make any health care decision the principal could make, after consultation with a physician or other listed practitioner, in accordance with the principal's wishes including religious and moral beliefs, or…

The Department's optional health care proxy form, with the agent and alternate designation, the artificial nutrition and hydration statement that PHL 2982 makes necessary, the duration and organ-donation options, and…

The Department's booklet reprints Executive Law § 135-c, which lets a registered electronic notary take an acknowledgment by audio-video communication technology where the principal is identified, the transmission is…

Defines health care agent, health care decision, health care proxy, attending practitioner, reasonably foreseeable and the other terms article 29-C uses, including the reach of health care decision over the withholding…

A competent adult may revoke a proxy by notifying the agent or a health care provider orally or in writing or by any act evidencing an intent to revoke, by executing a later proxy, and a proxy naming a spouse is revoked…

Article 29-C does not impair or supersede any other right to consent to or refuse treatment, and a living will or other written or oral expression of wishes remains admissible as evidence of the principal's wishes.

What the health care attorney in fact may decide, including the specific conditions the section imposes before life-sustaining treatment may be withheld or withdrawn, and the express statement required for nutrition and…

Where there is no declaration and no attorney in fact, this priority list decides. It is the default a client gets by doing nothing; walking through the order usually persuades a reluctant client to sign.

The authority and immunity of nurses and physician assistants acting under Ohio's DNR regime. Background that explains why a DNR is a clinician's instrument rather than one the client executes alone.

The defined terms for Ohio's health care power of attorney. Ohio keeps the health care power in chapter 1337 alongside the financial one but executes it differently; do not assume one set of formalities covers both.

Ohio: the health care power under section 1337.12 is signed at the end and dated. The principal signs or acknowledges the signature in each qualifying witness's presence, then the witnesses subscribe after the…

Ohio's printed statutory form for the health care power of attorney, with the notice to the principal the statute requires. Start from it.

OHIO'S LIVING WILL, called a DECLARATION. It must be signed at the end by the declarant or another at their direction, state the DATE of execution, and either be witnessed as the section requires or be ACKNOWLEDGED…

The declaration operates only when the declarant lacks capacity and the attending physician and a second physician make the determinations the section requires. A signed declaration in a drawer does nothing.

What the attending physician and a second physician must determine before a declaration operates, and the physician's duties once it does. The declaration does nothing until those determinations are made and recorded.

How an Ohio health care power is revoked, including the effect of divorce, dissolution or annulment on a spouse attorney in fact. A divorcing client who still wants their spouse to decide must say so expressly.

The agent may make any health care decision the principal could make, including admission to a facility, and the authority can extend past death to anatomical gifts, disposition of remains and consenting to autopsy.

A living will only becomes operative when a copy reaches the attending physician AND the physician determines the principal is incompetent and either has an end-stage medical condition or is permanently unconscious.

Unless the document says otherwise, it becomes operative when a copy reaches the attending physician AND the physician determines the principal is incompetent, and it becomes inoperative when the principal regains…

The physician must certify an end-stage medical condition or permanent unconsciousness in writing and record health care decisions in the medical record. The certification is what makes the client's document operate.

Notwithstanding a living will or an agent's decision, life-sustaining treatment, nutrition and hydration must be provided to a pregnant woman who is incompetent and has an end-stage medical condition or is permanently…

A living will must be dated and signed by the principal (or by another at the principal's direction if the principal cannot sign) and witnessed by TWO individuals 18 or older.

Pennsylvania: sections 5442 and 5452 require a dated living will or health care power signed by signature or mark, or, if unable to sign, by another specifically directed individual, and witnessed by two individuals…

Where there is no health care power of attorney or no available agent, a health care representative from the statutory class may decide, in the order and on the conditions given.

The defined terms that drive the whole chapter, including advance health care directive, attending physician, end-stage medical condition, life-sustaining treatment and permanently unconscious.

The principal signs in the presence of two qualifying witnesses, who also sign, or acknowledges the signature before a notary. At least one witness must satisfy section 166.003(2).

Each witness must be a competent adult; at least one must satisfy the listed relationship, care-provider and estate-interest restrictions. Read with the execution provision for the particular directive.

A Texas directive need NOT be notarised, and no health care provider or facility may require a particular form.

The Texas MEDICAL POWER OF ATTORNEY, a separate instrument from the financial durable power, and the agent's scope. Do not try to cover health care in the Estates Code power; the statutes are separate on purpose.

Texas: a directive to physicians under section 166.032 and a medical power of attorney under section 166.154 have separate execution provisions.

The statutory form of the Directive to Physicians, Living Will and Advance Directive. Start from it; it carries the choices and the explanations the statute expects.

Where there is no directive and no agent, this priority list of surrogates decides. The default a client gets by doing nothing; walking through it usually persuades a reluctant client to sign.

The medical power of attorney agent's right to receive the principal's medical information, which is what lets the agent act on real facts. Confirm the document grants it, and pair it with a HIPAA authorisation.

The medical power of attorney must substantially follow this statutory form, which includes its disclosure statement, agent designations, limitations and alternative execution blocks.

Texas's out-of-hospital DNR order, which is a clinician's order and a distinct instrument from the directive. A client who wants one must raise it with their physician.

A directive cannot authorize nontherapeutic sterilization, abortion or psychosurgery, and any provision conflicting with an emergency custody, temporary detention or involuntary admission order under Title 37.2 is void…

An agent appointed in an advance directive has authority to make the health care decisions the directive specifies once the declarant is determined incapable of making an informed decision, and takes decision-making…

A physician may refuse care he determines medically or ethically inappropriate, but only BASED SOLELY ON THE PATIENT'S MEDICAL CONDITION.

A lifetime anatomical gift may be made by the donor, including a minor at least fifteen years and six months old, by the donor's health care agent unless the directive prohibits it, by a parent of an unemancipated…

A declarant capable of understanding the nature and consequences of his actions may revoke an advance directive at any time by a signed and dated writing, by physical cancellation or destruction by himself or by another…

Without a directive, health care decisions fall to a statutory list in order: guardian, spouse, adult child, parent, sibling, other relative, and in limited cases a close friend, with stricter rules at the end of life.

Virginia: a written advance directive is signed by the declarant in the presence of two subscribing witnesses under section 54.1-2983. Confirm the adult declarant's ability to make and communicate an informed decision;

Optional suggested statutory form. Select the client's choices explicitly; do not grant every optional power by default. Some powers over protest include separate physician or psychologist attestations.

The directive's health care provisions take effect only after the attending physician, with a second capacity reviewer in most cases, personally examines the patient and certifies incapacity in writing, reassessed at…

An incapacitated patient's contemporaneous protest generally overrides the agent and the directive, except in narrow documented circumstances, and a protest alone does not revoke the document.