What Is a California Advance Directive?
A California advance directive is a legal document that lets an adult record health care wishes and appoint someone to make medical decisions if they can’t speak for themselves (CA Prob Code § 4701).
The directive can include treatment instructions or name a health care agent through a power of attorney for health care. Instructions may be written or shared verbally. It can also take effect right away or only under certain medical conditions, depending on how the document is written (CA Prob Code § 4670).
These instructions help doctors, family members, and caregivers understand what care someone wants. Many directives address life-support decisions, pain management, end-of-life care, and organ donation preferences. If an advance directive isn’t created, medical decisions still need to be made, and someone needs legal authority to act.
If you don’t create an advance directive, California law decides who makes health care decisions for you using a default priority order (CA Prob Code § 4712). Creating one lets you choose that person yourself instead of leaving the decision to the state.
What Does a California Advance Directive Include?
A California advance directive combines your medical care instructions and decision-making authority into one document. It allows you to explain the care you want and choose someone to make medical decisions if you can’t.
1. Written Health Care Instructions
One part of a California advance directive works similarly to a living will. It allows you to record medical treatment preferences in advance (CA Prob Code §§ 4605, 4670 – 4671).
You can explain the type of care you want or refuse and give guidance for future medical situations. Your directive may also authorize your agent to make any health care decision you could make if you had capacity (CA Prob Code § 4683(a)). Instructions commonly cover:
- Accepting or refusing medical treatment
- Pain relief and comfort care preferences
- End-of-life care decisions
- Organ or tissue donation (anatomical gifts) (§ 4683(b)(1))
- Autopsy authorization (§ 4683(b)(2))
- Funeral arrangements or disposition of remains (§ 4683(b)(3))
California also allows stand-alone psychiatric advance directives. These let you record mental health treatment preferences ahead of time, as long as the document meets advance directive requirements (CA Prob Code § 4679).
2. Power of Attorney for Health Care
The second part allows you to appoint a health care agent to act on your behalf (CA Prob Code §§ 4605, 4671). Your agent can make medical decisions to the same extent you could, unless you place limits in the directive (CA Prob Code § 4683). You may also nominate a conservator or guardian in case court involvement becomes necessary later (CA Prob Code § 4672).
California recognizes advance directives that were validly created in another state (CA Prob Code § 4676). A directive generally remains valid if it follows either that state’s law or California law, and health care providers may rely on it unless they know it’s invalid.
3. Organ and Tissue Donation
A California advance directive allows you to state whether you want to donate organs, tissues, or body parts after death. You can indicate whether you wish to make an anatomical gift or decline donation. These preferences help guide medical providers and your agent after your death (CA Prob Code § 4701).
4. Primary Physician
You may also designate the physician who will have primary responsibility for your health care. Naming a physician helps identify the provider who should oversee your treatment decisions if the directive becomes effective (CA Prob Code § 4701).
How Do You Complete and Sign a California Advance Directive?
To make a California advance directive legally valid, follow these signing steps required under state law.
1. Fill out and Date the Directive
Fill out the document and include the execution date. If you’re using the Legal Templates California Advance Directive, the form will guide you through entering your health care instructions and naming the person you’ve chosen as your agent. The completed directive should clearly reflect these decisions (CA Prob Code § 4673).
2. Sign the Directive
Sign the directive yourself. If you’re unable to sign, another adult can sign for you at your direction while you’re present.
3. Get It Notarized or Witnessed
California law requires either notarization or signatures from two qualified adult witnesses. Witnesses need to watch you sign or acknowledge your signature. They also need to meet certain eligibility rules (CA Prob Code § 4674):
- Adults age 18 or older
- Not your health care provider or facility staff
- Not your named health care agent
- At least one witness should be unrelated to you and not entitled to inherit from your estate
4. Complete Additional Steps for Skilled Nursing Facilities
If you sign the directive while living in a skilled nursing facility, a patient advocate or long-term care ombudsperson must also witness the signing to confirm it’s voluntary (CA Prob Code § 4675).
Health care providers and insurers can’t require you to sign an advance directive or stop you from revoking one as a condition for treatment, admission, or insurance coverage (CA Prob Code § 4677).
When Does a California Advance Directive Take Effect and How Long Does It Last?
A California advance directive usually takes effect when you lose decision-making capacity and remains valid unless you revoke or replace it. Your health care agent’s authority typically begins when you’re no longer able to make your own medical decisions. If you later regain decision-making capacity, your agent’s authority generally ends unless your directive says otherwise (CA Prob Code § 4682). The directive stays in effect unless one of the following happens:
- You revoke it
- You replace it with a new directive
- You include an expiration date in the document (CA Prob Code § 4686)
In other words, your directive stays ready to guide medical decisions whenever they’re needed.
Sample California Advance Healthcare Directive
Review a sample California advance directive below to see how the document is typically completed. When you’re ready, you can customize your own directive and download it in Word or PDF format.
How to Register Your Advance Health Care Directive in California
California offers an optional Advance Health Care Directive Registry managed by the Secretary of State (CA Prob Code § 4800). Registering your directive helps health care providers locate it if it’s needed during an emergency. To register your directive:
- Complete the Registration of Written Advance Health Care Directive form
- Submit a copy of your signed advance directive to the Secretary of State
- Keep the registry identification information you receive after registration
If you later revoke your directive or sign a new one, you’ll need to update or reregister the document (CA Prob Code § 4802).
Registration helps providers find your directive, but they generally can’t rely on it until they receive a copy. Registration also doesn’t prevent you from revoking or replacing your directive or determining which version controls if multiple directives exist (CA Prob Code § 4804).
How Do You Change or Cancel a California Advance Directive?
You can change or cancel a California advance directive at any time as long as you still have decision-making capacity. The process depends on which part of the directive you want to revoke.
To remove or replace your health care agent, you can:
- Sign a written statement revoking the agent designation, or
- Tell your supervising health care provider directly (CA Prob Code § 4695)
To change or cancel other parts of the directive, you can:
- Communicate a clear intent to revoke or modify your instructions, either in writing or verbally
Anyone who learns that you’ve revoked your directive should promptly notify your supervising health care provider and treating facility to keep your medical records up to date (CA Prob Code § 4696). Some life events can also automatically change parts of your directive. For example, divorce or annulment usually cancels your spouse’s authority as your health care agent unless you remarry that person (CA Prob Code § 4697).
If you create a new advance directive, it updates your instructions. Any conflicting terms in an older directive are replaced by the newer one (CA Prob Code § 4698).
