A California (CA) advance health care directive that stipulates all your health care preferences in case you are unable to communicate them, legally abiding by the laws of the state of California.
It’s comprised of two parts:
- Part one – medical power of attorney, give someone you trust the power to make medical decisions for you if you’re very sick.
- Part two – an advance directive, lets you describe what kind of healthcare you want. Both parts only go into effect if your doctor decides you’re not healthy enough to communicate your decisions.
Laws: California Probate Code Division 4.7, Part 2, Chapter 1 (Cal. PROB. Code) governs the creation of advance directives in California.
1. How to Fill in an Advance Directive in California
Make sure your California advance directive is valid and meets the legal requirements detailed in Cal. Prob. Code § 4000-4465 by following these steps:
Step 1: Choose an agent
Your agent is the individual who will make medical choices for you if you’re unconscious or too sick to communicate. Your agent will also communicate your healthcare wishes to your doctors based on what you’ve outlined on this form.
Who should you choose as an agent?
Your agent must be at least 18 years of age and should be a trustworthy person who knows your personal beliefs.
Your agent must follow the instructions you detail in your advance directive. If you don’t explicitly state your wishes in this form, your agent must consider your personal values to the best of their ability and make decisions in your best interest.
Relevant law: Cal. PROB. Code § 4684
Who can’t be your agent?
You can’t choose the following individuals to be your agent:
- Your doctor
- Anyone who works at your hospital or clinic, unless they’re your family member or co-worker
Relevant law: Cal. PROB. Code § 4659
Can you have more than one agent?
Yes, you can name up to three agents in a California advance directive. After your primary agent, you can name two others, known as your “alternate agent” and “second alternate agent.” If your primary agent can’t accept their appointment as agent, their powers are revoked and given to your alternate agents in the order their names are listed on your form.
Step 2: Specify what healthcare decisions your agent can make
You can decide how much power your agent has over your healthcare and post-death decisions.
Can you limit your agent’s authority?
Yes, you can write out any healthcare or post-death decisions you don’t want your agent to make on your California advance health care directive. For example, you could write: “I don’t want my agent to make choices about how my body should be treated after my death.”
What decisions can your agent make?
If you don’t include limitations on your form, your agent will be able to make all healthcare and personal, and some post-death decisions for you. Some examples are:
Healthcare decisions
- Approving tests, surgeries, or medications
- Selecting your healthcare providers and institutions
- Choosing whether to keep you alive with treatments like artificial nutrition and hydration
Personal decisions
- Deciding where you live
- Choosing what you eat
- Arranging caretakers and household employees
Post-death decisions
- Donating your organs or tissues
- Authorizing an autopsy
- Organizing funeral arrangements
What is your agent legally unable to do?
Your agent is prohibited by law from consenting to the following on your behalf:
- Convulsive treatment
- Psychosurgery
- Sterilization
- Abortion
- Placement in a mental health facility
Relevant law: Cal. PROB. Code § 4652
When can your agent start making decisions for you?
You choose whether your agent can start making decisions for you:
- immediately after your California advance directive is officially signed, or
- when your primary doctor determines you’re unable to make healthcare decisions
Relevant law: Cal. PROB. Code § 4682
Can you nominate your agent as your conservator?
Yes, you can nominate your agent as conservator or guardian of your person or estate (or both) for consideration by the court. If your agent is not able, your alternate agents can be nominated in the order they appear on your form.
Relevant law: Cal. PROB. Code § 4671
Step 3: Leave Instructions
This part of the form lets you outline your healthcare and post-death instructions (if any). Your agent and healthcare professionals must follow your instructions. To make sure your wishes are clear, try to answer the following questions:
Do you want your life prolonged?
Specify if you want your life prolonged for as long as possible in the event that:
- you have an incurable and irreversible condition that will result in your death soon
- you become unconscious and won’t regain consciousness
- the risk of treatment outweigh the expected benefits
- there’s any other scenario you want to describe
Do you want relief from pain?
Decide if you want treatment to help with pain or discomfort. You should discuss common pain management treatments and potential risks with your doctor before filling out this section.
Do you want to donate your organs and tissues?
Choose whether you want to donate your organs and tissues, or if you want to donate your body to scientific research.
If you choose to donate, you can restrict which parts of your body are donated, and what they’re donated for, including:
- Transplant
- Therapy
- Research
- Education
Do you have any other wishes?
If you have any other healthcare or post-death instructions, write them in this section of your California advance directive. For example, you can leave special instructions for if you become incompetent while you’re pregnant.
Do you want to designate a primary physician?
If you have a doctor that you’re familiar with, you can appoint them as your primary physician. You just need to include their name, phone number, and address.
Step 4: Sign the form
Date and sign your California Advance directive. If you’re unable to physically sign the document, another adult can sign for you, so long as you’re in the room and instruct them to sign it.
Do you need notary or witness signatures?
Yes. For your California Advance Directive to be legally-binding, it needs to either be:
- acknowledged by a notary public, or
- signed by at least two witnesses.
Relevant law: Cal. PROB. Code § 4673
Who can’t be a witness?
The following individuals can’t be a witness:
- Anyone under 18 years of age
- Your agent
- Your healthcare provider
- Your healthcare provider’s employee
- An operator or employee of a community care facility or care home for the elderly
Additionally, at least one of your agents can’t be:
- related to you by blood, marriage, adoption, or
- entitled to any portion of your estate under the last will.
Relevant law: Cal. PROB. Code § 4673
Special Witness Requirements
If you’re a patient in a skilled nursing facility, you’re required to have a patient advocate or ombudsman serve as a special witness.
Relevant law: Cal. PROB. Code § 4675
How to Revoke a California Advance Directive
So long as you’re competent, you can revoke your advance directive at any time by communicating that you want to revoke — for example — ripping up your advance directive form.
Alternatively, creating a new advance directive cancels the earlier version.
If you’re competent and want to revoke the designation of your agent, you can do so by:
- creating a written and signed revocation of power of attorney form, or
- personally informing your supervising healthcare provider
If your spouse is your agent, getting a divorce automatically revokes their powers as agents.
Relevant law: Cal. PROB. Code § 4695-4698