The Fourth Pillar: The AHCD

The Advance Health Care Directive

There are a myriad of ways to plan for health care decisions and it would be confusing to explain them all here. In California, the clearest and most widely accepted method is the Advance Health Care Directive (AHCD). This document has two main uses as it allows you to state your wishes regarding medical treatment and designates a health care agent to make medical decisions on your behalf when you are unable to.

Choices Regarding Life-Sustaining Treatment and Other Decisions

The choice of accepting life-sustaining treatment, such as cardiopulmonary resuscitation (CPR) or artificial respiration, is a personal choice that may conflict with the oath of a physician and the wishes of family to keep you alive. In the AHCD you may specify a very wide range of treatments you will accept and reject. You may also specify wishes for organ donation. In addition you may specify the kind of care facility you want to be in and the kind of environment you would like. However, the document only states your wishes. This is why it is important to designate an agent who will strongly advocate on your behalf to see your wishes fulfilled.

Designation of an Agent for Health Care Decisions

If you are no longer able to communicate with your physicians, your agent would speak on your behalf and would be responsible for managing your care. The agent may be given the power to end life support, choose doctors, consent to procedures, agree to medications, and many other options at your discretion. You may articulate a specific list of instructions for the agent to follow or you may grant the agent discretion.

Key Considerations: Avoiding Conservatorship

These decisions and talking to your loved ones can be challenging. So challenging that people tend to put these decisions on hold. We include the AHCD in the estate plan but you do not necessarily need an attorney to complete one as many hospitals prepare their own forms and the California Medical Association has a $15 packet that will accomplish the same task. However, don’t use that as a reason to put this off. Failing to complete the AHCD has dire consequences if it does not exist when needed. If you are unable to manage your affairs and make medical decisions, your loved one will have to go to court and ask to be appointed as a conservator, which is essentially the same thing as a health care agent. Yet this process is in the court system and thus expensive and public, not to mention totally unnecessary if we walk through the AHCD together.

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