An understated planning document is an Advance Healthcare Directive. People are often only introduced to the concept in formal estate planning settings or at a hospital. The directive lets people define the health care treatment when they can no longer make the decisions themselves, and who they would like to have speak on their behalf.

California ensures people have the right to make health care decisions in advance, the authority for this is contained in the California Probate Code Sections 4670 - 4743, and the example form you commonly find on the internet was published and codified into law. This form is widely used and recognized, but it is not necessarily the model or only form. Prepare for Your Care, a form developed by the Regents of the University of California, accomplishes the same goal of providing a method to, and is easier to read and fill. In other words, the authority to specify instructions on your health care is rooted in California law, and the form is just one way you can accomplish this.

The reason why this document is so important is because medical professionals often encounter ethical issues and conflicts when dealing with patients who either have no capacity (with no ability to speak or communicate their medical wishes) or with diminished capacity. Often the next of kin who are with the patient will not be making decisions either with a clear mind, or are conflicted themselves. An example of such a conflict can be when a paid caregiver, whose livelihood depends on the patient remaining alive, makes the decision to prolong life. Or members of a large family can have differing opinions as to what avenues of treatment to pursue. Compound this with the fact that it’s likely a very stressful time for all involved, the person making decisions on behalf of a patient who has given no direction cannot always consider the patient’s best interest. The directive allows people to maintain dignity in their most vulnerable state.

The reality of death

Contrary to popular belief, death isn’t instantaneous and many people lose capacity, however brief, before dying. It’s better to think of death as the dying process as opposed to the moment when life ends. In medicine, there are clinical signs of active death months before the heart stops beating or when the person takes their last breath. Patients in the process of dying are often in hospitals for days or weeks prior to the end of life.

Things to consider as you are filling out an Advance Directive

• Your people: think of several people who are nearby you trust. Do they have special knowledge and already know the types of treatment you’d like? Once you’ve made your selection and have written down their names on the form, let them know that you’ve listed them as a person to help you make health care decision.

• Whether you want to prolong life: in a hospital setting, without any direction from you to the contrary, medical staff will implement “full code”, which means they will do all they can to keep you alive if your heart stops beating, or if you stop breathing. If this is something you do not want, you need to specify it.

• Special instructions related to pain relief.

• Whether you would like your organs to be donated.

Once you’ve filled out an Advance Directive, where do you keep it?

Most hospitals and clinics now have digital portals where you can communicate with your doctor. This is now becoming the best place to store an advance directive. This upload can be accomplished from your phone or computer. If you need help uploading your directive to the portal, please contact your health care provider.

The California Secretary of State has an Advance Health Care Directive registry that it maintains for citizens to ensure that health care providers can have access to it in a central location. For $10, you can fill out a registration form, and mail it in with you directive to the Secretary of State to have it registered. If you would like to revoke, amend or register a new directive, you can do so by filling out this form and making a subsequent mailing to them.

Your friends and families can keep a copy. It’s important to note that copies of the directive has the same effect as the original, so you can make copies and distribute them freely to friends and family members who should know about your advance health care directives.