Can a Healthcare Directive Override a Family Member’s Medical Decisions?

What is the Effect of an Advance Health Care Directive on Family Members’ Decision-Making Capabilities?

In California, an Advance Health Care Directive (AHCD) is a powerful legal document that allows individuals to express their healthcare wishes and appoint a trusted agent to make crucial medical decisions on their behalf when they cannot do so. Emotions can run high when an individual is facing serious medical issues and their family is tasked with making difficult decisions on palliative care and life-sustaining treatments. 

The document can act as a vital guide for families during challenging times by allowing them to know exactly what care measures their incapacitated loved one would and would not want. 

A valid AHCD can also override a family member’s medical choices if they are not legally authorized to make those decisions or if their choices conflict with the individual’s stated preferences. The clarifying abilities of an AHCD may be able to prevent family-destroying disagreements and costly legal battles over end-of-life care. A knowledgeable health care directive attorney can explain the importance of a comprehensive AHCD and its relationship with family decision-making.

What is the Purpose of an Advanced Health Care Directive?

An Advance Health Care Directive (AHCD) is a legal document that serves two primary functions in California. First, it allows individuals to appoint a healthcare agent, also known as an attorney-in-fact, who has the legal authority to make medical decisions for them if they become incapacitated. Second, it enables individuals to document their healthcare wishes, such as refusing life-sustaining treatment in specific situations.

The AHCD has replaced previous forms like the Natural Death Act Declaration and the Durable Power of Attorney for Health Care in California. It offers more flexibility and comprehensive coverage of an individual’s healthcare preferences, allowing them to express their desires about healthcare in any situation where they may be unable to make their own decisions, not just in cases of terminal illness or permanent unconsciousness.

What Power Does an AHCD Have?

In California, an AHCD holds significant legal weight. When properly executed, it becomes a legally binding document that healthcare providers must follow. The wishes expressed in an AHCD or the decisions made by the appointed healthcare agent take precedence over the opinions or desires of family members who are not designated as agents. 

The legal authority of an AHCD is reinforced by California’s Health Care Decisions Law, which consolidated the state’s advance directive laws in 2000 to make it easier for individuals to communicate their preferences through written and oral communication. This law ensures that healthcare providers respect the decisions outlined in a valid AHCD. To fight the terms of an AHCD, a family member or interested party would have to demonstrate by a preponderance of evidence that the document was invalid due to the mental incapacity of the individual at the time of its creation, coercion from an outside source, or another allowable reason.

What Rights Do Family Members Possess for Medical Decision-Making if No AHCD Exists?

In the absence of an AHCD, family members in California do not automatically have the authority to make medical decisions for an incapacitated individual. In these cases, family members may find themselves in a confusing and potentially contentious situation, unsure of who should make decisions or what those decisions should be.

In the past, California law gave hospitals and healthcare providers significant discretion to make medical decisions on behalf of an incapacitated patient without an AHCD. Sometimes, these choices conflicted with the preferences of family members and friends familiar with the patient’s wishes. However, an amendment to the state’s probate code that went into effect on January 1, 2023 now provides a list of next-of-kin who can make decisions. Currently, medical providers must make a good-faith effort to identify an individual who can serve as an authorized representative.

However, any individual eligible under the law can potentially be chosen as a surrogate for the incapacitated person. The hospital still retains significant leeway to designate a representative, which can have serious ramifications, particularly when families disagree on care decisions. Having a valid, thoughtfully drafted AHCD is the only way to be certain your health care wishes will be honored and someone you trust will make your medical choices if you cannot.

How Can an AHCD Nullify a Family Member’s Opinions on Medical Care?

An AHCD can effectively override a family member’s medical decisions in several ways:

• Appointed agent: If the AHCD designates a specific person as the healthcare agent, that individual’s decisions take precedence over those of other family members, even if they are next-of-kin
• Specific instructions: If the AHCD contains specific instructions about medical treatments or end-of-life care, these instructions must be followed regardless of family members’ opinions
• Legal protection: Healthcare providers are legally obligated to follow the instructions in a valid AHCD, protecting them from potential disputes with family members who disagree with the document’s contents

How Can Individuals Avoid Major Family Arguments Over Care Decisions?

Given the potential for conflicts between an AHCD and family members’ wishes, it’s crucial for individuals to communicate their healthcare preferences clearly and in advance. By taking these steps, individuals can help prevent painful family disagreements, ensuring their healthcare wishes are respected and reducing the emotional burden on their loved ones during difficult times:

• Discuss wishes: To prevent surprises, have open conversations with family members about your healthcare preferences and the contents of your AHCD
• Choose an agent carefully: When appointing a healthcare agent, select someone who understands and respects your wishes and can effectively communicate with other family members
• Be mindful of potential disagreements: If you are aware that some family members may not agree with your stated choices, choose an agent who is comfortable with possible conflict and inform them of the situation so they can be prepared
• Perform regular updates: Review and update your AHCD frequently to ensure it continues to reflect your current wishes and circumstances
• Follow legal requirements: Ensure your AHCD is properly executed according to California law, which typically requires either two adult witnesses or notarization
• Communicate clearly: Once your AHCD is completed, provide a copy to your agent, health care provider, and other relevant entities. Discuss the contents with your doctor to ensure they are aware of the document and its terms

How Can Our Experienced Lawyers Assist With Your AHCD?

An AHCD is a highly effective and important legal document that allows you to express your desires about healthcare in any situation where you may be unable to make and communicate your own decisions. Its usefulness can extend beyond cases of terminal illness or permanent unconsciousness to acute injuries or illnesses. By clearly expressing your healthcare wishes and appointing a trusted agent, you can make certain your preferences are respected, even in situations where family members might disagree. 

However, it’s essential to approach this process with care, communication, and regular updates to minimize potential conflicts and ensure the best possible outcomes in challenging medical situations. To begin drafting an AHCD that provides you and your loved ones with peace of mind, contact Cava & Faulkner today at 916-831-7565 and schedule a free consultation.