An advanced health care directive is a legal document that lets you decide who speaks for you on medical matters, and what care you want, if you cannot speak for yourself. In California, it is the document that keeps your doctors, your family, and your own wishes on the same page during a crisis.
Without one, your family may not know who has authority to decide, and they may disagree about what you would want. Hospitals then follow California’s default rules, which may not match your wishes. Instead, a directive replaces that guesswork with your own choices, in writing.
This guide explains how a California advance health care directive works, what it includes, how to sign one correctly, who can act for you, how it differs from a POLST, and how to keep it current. It is general information, not legal advice. Your situation matters.
Key Takeaways
- It does two jobs. You can name an agent to make health care decisions, and you can write instructions about the care you want or do not want.
- Anyone can use the state form. California’s statutory form in Probate Code §4701 has five parts, including optional organ donation.
- Sign it correctly. You need a date and your signature, plus a notary or two qualified witnesses (Probate Code §4673).
- Register it if you want. The Secretary of State registry is voluntary, and a directive stays valid without it.
- Review it often. Your wishes, your health, and your family can change.
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The Short Version
- Who needs one: Every adult. After all, a sudden illness or accident can leave you unable to speak at any age.
- What it does: It names your agent, records your treatment wishes, and can include organ donation and your primary physician.
- What it avoids: Family conflict, hospital guesswork, and in some cases a court-supervised conservatorship.
- What it is not: It does not manage your money. Instead, a financial power of attorney does that.
What Is an Advance Health Care Directive in California?
An advance health care directive (often called an AHCD) is a written document that records your health care decisions before you need them. California law lets it do several things. Under Probate Code section 4672, a written directive can also include your nomination of a conservator or guardian, for a court to consider if protective proceedings ever begin.
Most directives combine two ideas that people often hear as separate documents:
- A power of attorney for health care. You name an agent, sometimes called a health care proxy, who makes medical decisions for you.
- Individual health care instructions. You write what care you want, what you do not want, and the values behind those choices. People often call this a living will.
You do not have to use both, because you can name an agent without writing instructions, or write instructions without naming an agent. Most people do both, because instructions cannot cover every situation and an agent can fill the gaps.
What Does the California Statutory Form Include?
California provides a statutory form in Probate Code section 4701. The form says you can complete it, change it, or use a different form. It has these parts:
- Part 1, power of attorney for health care. You name an agent and up to two alternates. Unless you limit the agent, the agent can make all health care decisions, including decisions about artificial nutrition and hydration.
- Part 2, instructions for health care. You choose between two end-of-life options. One says not to prolong life under certain conditions. The other says to prolong life as long as possible within generally accepted standards. You can also direct pain relief, even if it may hasten death, and add your own written wishes.
- Part 3, donation of organs, tissues, and parts (optional). You can choose to donate and say for what purposes, such as transplant, therapy, research, or education. Leaving this part blank is not a refusal.
- Part 4, primary physician (optional). In addition, you can name a primary physician and a backup.
- Part 5, execution. You sign and date the form, and two qualified witnesses sign declarations, or you use a notary.
A separate Part 6 applies only to patients in skilled nursing facilities, as described below.
Many attorneys draft a custom directive instead of using the form. A custom document can cover specific conditions, such as advanced dementia, and add instructions the form does not include.
What Can Your Health Care Agent Do?
Your agent steps in only when you cannot decide for yourself. Under the statutory form, the agent’s authority starts when your primary physician finds you unable to make your own decisions, unless you check the box that makes it effective immediately.
An agent generally can:
- Consent to or refuse treatment, within the limits you set.
- Choose or change doctors and facilities.
- Handle medical information. Under Probate Code section 4678, unless your directive says otherwise, a person authorized to make decisions for you has the same rights you have to request, receive, examine, copy, and consent to the disclosure of your health care information.
- Make decisions about artificial nutrition and hydration, unless you limit that power.
However, an agent cannot do everything. For example, California law does not let an agent consent to your commitment to or placement in a mental health treatment facility. The statute also excludes convulsive treatment, psychosurgery, sterilization, and abortion from what an agent or surrogate can consent to (Probate Code §4652).
How Does Your Agent Decide?
Fortunately, California law gives your agent a clear standard. Under Probate Code section 4714, a surrogate must make decisions in accordance with your individual health care instructions and other wishes, as far as the surrogate knows them. If the surrogate does not know your wishes, the surrogate decides in accordance with your best interest, and considers your personal values as far as the surrogate knows them.
For this reason, the conversation matters as much as the document. An agent who understands your values can apply them when your instructions do not fit the situation.
Providers can still decline some requests. Under Probate Code section 4735, a provider or institution may decline to comply with an instruction or decision that is medically ineffective, or that conflicts with the generally accepted health care standards that apply to the provider.
How to Sign a Valid Advance Health Care Directive in California
Probate Code section 4673 says a written directive is legally sufficient if:
- It has a date. The directive contains the date you signed it.
- You sign it. You sign it, or another adult signs your name in your presence and at your direction.
- A notary or two witnesses confirm it. Either a notary public acknowledges it, or at least two witnesses who meet the requirements of §§4674 and 4675 sign it.
Who Can Witness Your Directive?
Under Probate Code section 4674, witnesses must be adults. At least one witness must not be related to you by blood, marriage, or adoption, and must not be entitled to any part of your estate. The following people cannot serve as a witness:
- Your health care provider or an employee of your health care provider.
- The operator or an employee of a community care facility.
- The operator or an employee of a residential care facility for older adults.
- Your agent, if the directive is a power of attorney for health care.
Special Rule for Skilled Nursing Facilities
If you are a patient in a skilled nursing facility when you sign, Probate Code section 4675 says the directive is not effective unless a patient advocate or ombudsman signs it as a witness. That person can serve as one of two witnesses or in addition to notarization. This is the rule that families miss most often when a loved one needs a directive during a facility stay.
Notary or Witnesses: Which Is Better?
Either method meets the law. Still, a notary is often the simpler choice, because it avoids hunting for two qualified adults and avoids witness disputes later. Also, check that your signing method matches your setting, especially in a facility.
How Is a Directive Different From a Financial Power of Attorney?
People often mix these up, but they are separate documents with separate agents.
| Advance Health Care Directive | Durable Power of Attorney (Financial) | |
| What it covers | Medical decisions and treatment wishes | Money, property, taxes, and bills |
| Who acts | Your health care agent | Your financial agent |
| Can one person do both? | Yes, but you can choose different people | Yes |
| Main law | Health Care Decisions Law (Probate Code Division 4.7) | Probate Code Division 4.5 |
| Needs witnesses or notary? | Yes (§4673) | Yes (§4121) |
Many people name the same trusted person for both roles, while others split them, for example a child who is good with money and a spouse who knows their medical wishes. Read what a durable power of attorney covers in California before you decide.
Advance Health Care Directive vs. POLST
A POLST is not the same as an advance directive, and seriously ill patients often need both.
| Advance Health Care Directive | POLST | |
| What it is | A planning document you write | A medical order signed by a provider |
| Who signs | You, with witnesses or a notary | You (or your legal decisionmaker) and a licensed provider |
| Who should have one | Every adult | People with serious illness or advanced frailty |
| When it applies | If you cannot decide for yourself | Right away, including in an emergency |
| Names an agent? | Yes | No |
According to Bay Area Legal Aid’s overview, a POLST is not for healthy adults. It is a medical order that emergency responders and clinicians can follow on the spot, while an advance directive is a broader planning document. If your doctor recommends a POLST, ask how it fits with your directive, and review both after any major change in your health.
What Happens if You Have No Directive?
If you lose capacity and have no legally recognized decisionmaker, California law gives providers a path. Under Probate Code section 4712, a health care provider or a designee of the facility can choose a surrogate. The list of people the provider can choose from includes:
- Your spouse or domestic partner.
- An adult child.
- A parent.
- An adult sibling.
- An adult grandchild.
- An adult relative or close personal friend.
AB 2338 added this rule, and it took effect on January 1, 2023. Before the provider chooses, the law looks first to a surrogate you designated yourself while you had capacity, an agent named in a directive or power of attorney for health care, or a conservator or guardian with health care authority.
This default process has problems. For example, the person the provider picks may not be the person you would choose. Adult children can disagree, and a close friend or unmarried partner may not appear on the list at all. In contrast, a directive lets you pick your own decisionmaker and keeps your family out of the argument.
Can You Name a Surrogate Without Paperwork?
Yes, in limited cases. Under Probate Code section 4711, a patient may designate an adult as a surrogate by personally informing the supervising health care provider or a designee of the facility. Then the provider must promptly record it in the patient’s health care record. This option helps in a hospital stay, but it is not a substitute for a written directive.
Not Sure What to Put in Your Directive? Talk It Through
Most people can fill out a form, but the hard part is deciding what you want and who should carry it out. A short conversation can help you choose an agent, think through your instructions, and make sure the document works with the rest of your plan.
Schedule Your FREE 30-Minute Health Care Directive Review
Decisions to Make Before You Sign
Think through these questions, and then talk with your agent about the answers:
- Life support. Would you want a ventilator or CPR if recovery is unlikely?
- Feeding and hydration. Would you want artificial nutrition and hydration, and for how long?
- Pain relief. Do you want comfort care, even if it may hasten death?
- Long-term conditions. What would you want if you developed advanced dementia or lost the ability to recognize your family?
- Where you want care. Do you want to stay at home if possible?
- Organ donation. Do you want to donate, and for what purposes?
- Faith and values. Are there beliefs your agent should respect?
Write your answers in your own words, even if you use a form, because specific values help your agent more than a checked box.
How to Choose Your Health Care Agent
Your agent may have to make hard choices under pressure, so choose someone who:
- Understands your wishes and will follow them even if they disagree.
- Can stay calm in a hospital setting.
- Is available or can travel quickly.
- Can stand up to family and providers, if needed.
- Will say yes. Ask first. Do not name someone without their agreement.
Next, name an alternate. Under the statutory form, you can name up to two. Review your choices after any major family change.
Where to Keep Your Directive and Who Should Have It
A directive no one can find does not help. Also, under the statutory form, a copy has the same effect as the original.
- Give copies to your agent and alternates.
- Give a copy to your primary doctor and ask them to put it in your chart.
- Tell family members who your agent is and where the document is.
- Keep the original somewhere your agent can reach, not in a locked safe deposit box.
- Consider registering it. According to the California Secretary of State, registration is entirely voluntary and costs $10.00 per registration or new directive. Note that you must mail the form with the fee. Only you, your providers, your conservator, and your named agent can access the information. Even so, the directive is still valid without registration.
Can You Change or Revoke It?
Yes. You can replace your directive at any time while you have capacity.
Under Probate Code section 4695, a patient who has capacity may revoke the designation of an agent only by a signed writing or by personally informing the supervising health care provider. When you sign a new directive, first state that it replaces all earlier ones, collect and destroy old copies, and give the new one to everyone who had the old one.
Review your directive when:
- You marry, divorce, or lose a spouse.
- Your agent moves, becomes ill, or can no longer serve.
- Your health changes.
- Your values change.
- You move to another state.
Does a California Directive Work in Other States?
California recognizes directives from other states, and the reverse often works too. Under Probate Code section 4676, a directive signed in another state that follows that state’s law, or California’s law, is valid and enforceable in California to the same extent as one signed here. A provider can presume a directive is valid when they do not know otherwise.
However, other states set their own rules for California directives, and I cannot speak for all of them. If you spend time in another state, carry a copy and ask an attorney there whether you need a local form.
Common Mistakes With an Advance Health Care Directive
- Waiting until you are sick. You must have capacity to sign.
- Naming no alternate. If your agent cannot serve, your family may end up in the default process.
- Skipping the conversation. Otherwise, an agent who never heard your wishes may guess.
- Using the wrong witnesses. A health care provider, a facility employee, or your own agent cannot witness.
- Missing the skilled nursing facility rule. Therefore, a directive signed in such a facility is not effective without a patient advocate or ombudsman.
- Confusing it with a POLST. The directive is a plan, while the POLST is a medical order.
- Forgetting the financial side. A health care directive does not manage your money.
- Never updating it. As a result, old directives can name people who no longer fit.
Get Your Directive Reviewed by a California Attorney
I’m Jolene Blackbourn, a California estate planning attorney. Specifically, I help clients choose the right agent, put their wishes in clear words, and coordinate their directive with their trust, their will, and their financial power of attorney. If you already have a directive, I can check whether it still works.
Book Your FREE 30-Minute Estate Plan Review
Our California advance health care directive service can help you prepare this document as part of a complete plan.
Frequently Asked Questions (FAQs)
| Question | Answer |
| What is an advance health care directive in California? | A written document where you name an agent to make medical decisions for you, give instructions about your care, or both. |
| What is the difference between a living will and an advance directive? | A living will is the part of a directive that records your treatment wishes. An advance health care directive can include that part and also name an agent. |
| Who should have an advance health care directive? | Every adult. Illness and accidents can leave anyone unable to speak for themselves. |
| Does a directive need to be notarized in California? | No. Under Probate Code §4673, you need a date and your signature, plus either a notary or at least two qualified witnesses. |
| Who cannot witness my directive? | Your health care provider or their employee, the operator or an employee of a community care facility or residential care facility, and your agent (Probate Code §4674). At least one witness must not be related to you and must not stand to inherit from you. |
| What if I live in a skilled nursing facility? | A patient advocate or ombudsman must sign as a witness, or the directive is not effective (Probate Code §4675). |
| When does my agent’s authority begin? | Under the statutory form, when your primary physician finds you unable to decide, unless you choose to make it effective immediately. |
| Can my agent make any medical decision? | Not any. California law does not let an agent consent to commitment to a mental health facility, and it excludes convulsive treatment, psychosurgery, sterilization, and abortion (Probate Code §4652). |
| What standard does my agent follow? | Your instructions and known wishes first. If those are unknown, your best interest, considering your personal values (Probate Code §4714). |
| Can my doctor refuse to follow my directive? | A provider can decline an instruction that is medically ineffective or conflicts with accepted standards (Probate Code §4735). |
| What happens if I have no directive? | A provider or facility designee can choose a surrogate from a list that includes your spouse, adult children, parents, siblings, grandchildren, and close friends (Probate Code §4712). |
| What is the difference between a directive and a POLST? | A directive is a planning document you write. A POLST is a medical order signed with a provider, and it is for people with serious illness or advanced frailty. |
| Do I need to register my directive? | No. Registration with the Secretary of State is voluntary and costs $10.00. Your directive is valid without it. |
| How do I revoke my directive? | While you have capacity, you can revoke the designation of an agent by a signed writing or by personally telling your supervising provider (Probate Code §4695). Sign a new directive to replace the old one. |
| Is a California directive valid in other states? | California honors valid out-of-state directives (Probate Code §4676). Other states set their own rules, so check before you travel or move. |
| Can the same person be my health care and financial agent? | Yes. Many people name one person for both, and others choose different people for each role. |
| Do I need a lawyer to make a directive? | Not required, because California offers a statutory form. A lawyer can help you choose an agent, write specific instructions, and match the document to the rest of your plan. |
