1. Advanced Estate Planning: Introduction
  2. Advanced Estate Planning: Information For Caregivers And Survivors
  3. Advanced Estate Planning: Setting Up Your Will
  4. Advanced Estate Planning: Healthcare Documents
  5. Advanced Estate Planning: Durable Power Of Attorney For Finances
  6. Advanced Estate Planning: Using Trusts
  7. Advanced Estate Planning: Child Care Documents
  8. Advanced Estate Planning: Reviewing Life Matters And Planning
  9. Advanced Estate Planning: Final Arrangements
  10. Advanced Estate Planning: Executor Selection And Guide
  11. Advanced Estate Planning: Conclusion

By Steven Merkel

A healthcare directive, also tied in with a living will or power of attorney, is used to name a trusted person to oversee the execution of your wishes for medical care that you do or do not want to receive at the end of your life. In essence, your healthcare directive will give this person the authority to make decisions on your behalf should you be unable to make them for yourself. In several states, the living will, power of attorney and healthcare surrogate can be combined into one document known as the "healthcare directive." You should check with the specifics of your state law to fully understand which documents are recognized and required in your state.

You should draft your healthcare directive in the state in which you permanently reside. However, all states will honor documents created in other states, so it is not necessary or recommended to make multiple documents if you reside in more than one state.

Appointment of a Healthcare Surrogate
If you're unable to make healthcare decisions on your own behalf, it's solid planning to have a document that names a trusted person to make healthcare decisions for you. The healthcare directive is such a document. In creating this document, you should name a person to act as your primary surrogate and another person as your alternate surrogate. In selecting these individuals, choose someone who is very dependable and trustworthy. Your parents, a spouse, a partner, a relative or a close friend are all common choices. Once you decide on who you would like to designate as your surrogate, you should ask the person if they are willing to do the job before you name them in your directive.

If you do not appoint your own healthcare agent, state law will appoint one for you in case you are unable to make these decisions on your own. In many cases, this can be time consuming and costly, thus hindering your immediate care. If the court must appoint a guardian, you should nominate your primary and alternate surrogates in the directive document to serve without bond or security.

Living Will
The second part of your overall healthcare is the document describing the types of medical treatment that you would or would not like to receive under certain conditions. This document is known as your living will. (For more about livings wills, read 3 Documents You Shouldn't Do Without.)

Contact Information
Because many healthcare primary and alternate surrogates do not know all of the material information regarding your current health, records, physicians and insurance documents, it's important for you to have a section in your healthcare directive that includes the following information:

  • Your primary physician
  • An alternate physician
  • Your preferred hospital
  • Your medical and insurance records
  • Your primary and alternate surrogate contact info
Declaring Special Wishes
In some instances, you might have special religious or personal beliefs that you want your healthcare surrogate to uphold. These wishes should be described in detail in your directives document and might include specific requests relating to burial, cremation, organ donation, autopsy rights and life support options. If you do not have specific requests in these areas, you can leave those decisions up to your surrogate to decide for you. Make sure that your wishes in your healthcare directive match those stated in your final arrangements document, as this will avoid any confusion about your true wishes.

Surrogate's Authority
Your surrogate or "agent" will be granted the power to act for you should you be unable to make your own decisions; therefore, you'll want to acknowledge in your document the following powers and authority:

  • The ability to visit you in any medical facility
  • The ability to sign documents to allow transfer to different medical facilities
  • The ability to hire and terminate any medical staff
  • The ability to sign all waiver and releases of medical liability
  • The ability to sign documents to obtain medical records
  • The ability to review information regarding your physical and mental health
  • The ability to authorize all admission and release documents
You can also specifically authorize your surrogate to make decisions for you about whether to withhold or withdraw life-support procedures, including artificially administered nutrition and hydration.

Effective Date and Obligations
The effective authority of your surrogate should be defined in your directive document. A common way to effect the document is to give power when your primary physician or another authorized medical provider determines that you are incapable of making informed decisions regarding your own healthcare. In any case, the signing and witnessing of the directive document identifies your personal surrogate and grants them authority to assess your capacity to make informed decisions regarding your healthcare.

Your surrogate's obligation is to make decisions in accordance with those specified in your healthcare directive. Should particular areas of care not be specified in the document, your surrogate will make decisions for you and attempt to do what is in your best interest. In determining this, they should consider your personal values, those of other family members, and professional medical recommendations.

Finalization, Letter to Surrogate and Safekeeping
In finalizing of your healthcare directive document, you will need to sign and date it, as well as list the location where the document was signed (city, state, county). While declaration requirements will vary from state to state, if you have two witnesses sign the document as well as have it notarized, you will fulfill most state requirements. Pay particular attention to ensure that none of your primary or alternate surrogates has signed the document as a witness or notary, as this could invalidate the document in some states.

Lastly, you should prepare a letter for your surrogate confirming his or her appointment. This letter should only be given to the surrogate(s) (primary and alternate) as a courtesy to notify them that they have been selected. You will simply ask your surrogate to follow your instructions in accordance with the healthcare document and make other decisions that arise in regards to your health. Distribute this document as you see fit, but one copy should go to your primary surrogate and another in a safe place in your home.

Advanced Estate Planning: Durable Power Of Attorney For Finances
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