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We all need to protect our rights. No member of our community should be without a Advance health Care Directive (AHCD), formerly known as the Durable Power of Attorney for Health Care )DPAHC). The new AHCD should be used in place of the old DPAHC after July 1, 2000.

If you are injured or become seriously ill, the legally binding document on the following pages can protect you and your decisions. Read the explanation below before filling out the form. Questions? Call the AIDS Legal Referral Panel at (415) 291-5454 or (510) 451-5353. Other legal resources are listed below. There's no time like the present to have an AHCD.

Why and How: The Durable Power of Attorney for Health Care by Ora Prochovnik, Professor' New College School of Law; ALRP Volunteer Attorney

If you suffer a serious injury, illness or mental incapacity, it may be impossible for you to make health care decisions for yourself. The legal document on the following pages is a Durable Power of Attorney for Health Care (DPAHC). It provides information about your treatment preferences to those caring for you, helping to insure that your wishes are respected even when you cannot make decisions yourself. The DPAHC allows you to choose a personal representative, called an "attorney-in-fact," to make decisions according to the guidelines you set out in the form. A clearly written DPAHC helps to prevent disagreements among those close to you and alleviates some of the burdens of decision-making which are often experienced by family, friends and health care providers. If there is a conflict with legal relatives, the DPAHC will insure that the decisions of the person you name as your attorney-in-fact take precedence over the wishes of anyone else, including your blood relatives. Further, your doctor is legally obligated to consult with your chosen representative, and to respect his or her decisions and implement them as if they were your own.

The person you appoint as your attorney-in-fact has the legal right to accept or refuse medical treatment on your behalf. Your attorney in-fact is empowered to carry out your wishes. You should choose a person who knows you well, someone who is familiar with your feelings about different types of medical treatment and the conditions under which you would accept or refuse certain treatments. Select someone in whose judgment you have confidence; choose someone whom you trust to follow your wishes. You are not allowed to appoint your health care provider or an employee of your health care provider --for instance, do not name a friend who works as a nurse at the hospital where you receive treatments. It is also advisable to name a second choice, in case the person you have selected is unable to serve.

The California Statutory DPAHC form, contained in the accompanying PDF (Portable Document Format), is easy to complete.

Section 1: Insert your name and address in the first blank space. In the second blank space, fill in the name, address and phone number of the person you've chosen to be your attorney-in-fact.

Sections 2 & 3: Read

Section 4: The blank spaces at section 4 are probably the most important part of the form. If you have any special concerns about particular treatments, this is your opportunity to clearly express those concerns in your DPAHC. There are no rules about what should be said here. Write down anything which should guide your attorney-in-fact and your medical practitioners in making treatment decisions on your behalf. If the space provided on the form is not sufficient for all of your specific instructions, write the words "see attached" in the blank spaces, and attach additional pages.

In section 4a, you should express your desires regarding the use of life-sustaining treatment. If there are medical conditions which would lead you to decide to forgo all medical treatment, including life-sustaining measures, and accept an earlier death, this should be clearly indicated. One example of a statement regarding the termination of life sustaining treatment is:

¥ I do not want my life to be prolonged and I do not want life-sustaining treatment to be provided or continued if a) I am in an Irreversible coma or persistent vegetative state or b) If I am terminally ill and the application of life sustaining procedures would serve only to artificially delay the moment of my death; or c) under any other circumstances where the burdens of the treatment outweigh the expected benefits I want my agent to consider the relief of suffering and the quality of my life as well as the extent of the possible extension of my life in making decisions concerning life-sustaining treatment. Life-sustaining treatment as used herein is meant to include the provision of nutrition and hydration.

You can also specifically request medical treatments in the DPAHC. An example of a statement that can be used to request that all measures be taken to sustain your life is:

¥ I want my life to be prolonged to the greatest extent possible without regard to my condition, the chances I have for recovery or the cost of the procedures.

In section 4b write down any other special instructions affecting your medical care. You may include any, all or none of the following examples, or you may write your own statement of desires. Instructions must be clear, but they do not need to be written in "legalese."

¥ My attorney-in-fact shall be given first priority in visitation should I be a patient in any hospital, health care facility or institutions, and should I be unable to express a preference due to my illness or disability or death, and to have visitation rights with me to the same extent as a member of my immediate family.

 

¥ My attorney-in-fact is authorized to receive into his/her possession any and all items of personal property and effects that may be recovered from or about my person by any hospital, police agency, or any other person at the time of my illness, disability or death.

 

¥ I direct my attorney-in-fact to consent to and arrange for the administration of pain relief medication of say kind, or other surgical or medical procedures calculated to relieve my pain, even though their use may lead to permanent physical damage, addiction, or may even hasten the moment of of (but not intentionally cause) my death, and to authorize, consent to, and arrange for unconventional pain relief therapies that my Agent believes may be helpful to me.

 

¥ I am primarily concerned with maintaining a clear cognitive awareness of myself and my environment during the course of my illness. I therefore authorize my attorney-in-fact to refuse and prevent any drug treatment of myself which in his/her opinion causes, or would cause a temporary or permanent mental incapacity or impairment of my cognitive abilities.

 

¥ I grant my attorney-in-fact sole and complete authority to determine the proper mode of treatment. This authority shall include the selection of alternative healing techniques and non-Western medicines, including, but not limited to, acupuncture, chiropractory, homeopathy, etc.

Sections 5, 6 & 7: Read

Section 8: Leave the blank space at section 8 empty. Your DPAHC will then have no automatic time limit. You can choose to revoke your DPAHC at any time.

Section 9:Insert the names, addresses and telephone numbers of one or two alternates in the blank spaces.

Section 10: In the blank space, insert the phrase "my Agent as set forth in Sections 1 and 9, above." By doing this you are nominating the person you chose as attorney-in-fact to also be your conservator, should a court decide that a conservator must be appointed. {A conservator is an individual or agency appointed by the court to manage your care or your property should you become incompetent.)

Section 11: You must sign the completed DPAHC form in the presence of two witnesses. It is best if both witnesses are people who are not related to you, are not named in your Will, and are not your health care provider or an employee of your health care provider. On the day you sign the document, fill in the date at section 11, as well as the city where you are signing. Then sign your name on the space indicated. Your witnesses should then fill in their names and addresses, and each should sign and date the form at the bottom. Note that each witness should sign the form twice. At this time you should also date and sign any additional pages you have attached to the form.

What to do with the completed form: You should hold onto the original DPAHC. Keep it with your other important legal papers. It is a good idea to give a copy to the person(s) you named as your attorney-in-fact and as alternates. A copy should also be given to your doctor, your family and others who are important to you. If you enter a hospital, nursing home or hospice, a copy should be provided to the institution so that it can be made part of your medical records. Keep a list of all the people to whom you have given a copy with the original document in your possession. This way, if you later revoke your DPAHC, you can easily contact them and get back the copies.

Use this opportunity to carefully consider the important issues raised while completing the DPAHC. And remember-a properly completed form is a legally binding document. Help ensure that your decisions will be respected by carefully following the instructions detailed above. There's no time like the present to protect your rights and decisions.

DOWNLOAD AHCD FORM

(You'll need Adobe Acrobat Reader.)

(Make sure you download and install the Reader.)

Questions?

Call AIDS Legal Referral Panel @ (415) 291-5454 or (510)451-5353

or call one of these other legal resources:

Gay Legal Referral Service: (415) 621-3900

National Center for Lesbian Rights (415) 392-6257

Berkeley Community Law Center - HIV Project ( Alameda County Only) (510) 548-4040