Health care decisions are decisions made by a patient or the patient’s agent, conservator or surrogate, regarding the patient’s health care, including the selection and discharge of health care providers and institutions, approval or disapproval of diagnostic tests, surgical procedures, and programs of medication, and directions to provide, withhold, or withdraw artificial nutrition and hydration and all other forms of health care, including cardiopulmonary resuscitation.

These are the decisions that most people hope to be present and conscious enough to make for themselves, but in fact they are the very decisions that they will be least likely to be able to make. That is, unless they have made their plans and desires known beforehand. These choices should be based upon the client’s values, which have their roots in culture, family, religion, medicine, and many other sources.

More and more people are becoming familiar with the “Advance Health Care Directive” (AHCD), particularly as many nonprofit and public health advocacy organizations have publicized it and made it available and convenient to fill out. The AHCD actually includes two components, an “individual health care instruction,” and a “power of attorney for health care” (PAHC). A PAHC is a written document which designates an agent for health care decision making, while the “individual health care instruction” does not need to name an agent.

A well-thought out PAHC can help to avoid the need of a conservatorship. However, the agent under a PAHC does not have the power to commit the principal to a mental treatment facility or to authorize certain procedures. (Placement of the principal in mental facilities or secured perimeter facilities for dementia patients requires a conservatorship under the Lanterman-Petris-Short Act, or probate conservatorship of the person with special powers.)

Certain persons are prohibited from serving under a PAHC because of obvious conflicts of interest. These include a supervising health care provider, an employee of the health care institution, and a community care facility or residential care faciliy operator. 

Click on these links for additional resources: 

Attorney General's AHCD Site

California Advocates for Nursing Home Reform

Santa Cruz County End-of-Life Coalition

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Images, from top: 

Crown Rock & Natural Arch, ca. 1905

State Highway (9) near Inspiration Point, ca. 1920