Advance Care Plans

Five Types of Advance Directives in New York State

• A health care proxy lets you appoint a health care agent—someone you trust to make health care decisions for you if you are unable to make decisions for yourself.
• A living will allows you to leave written instructions explaining your health care wishes, especially about end-of-life care. You cannot use a living will to name a health care agent; you must use a health care proxy.
• A living will together with a health care proxy lets you state your health care wishes and name a health care agent.
• A do not resuscitate order (DNR) only lets you express your wish to do without cardiopulmonary resuscitation (CPR)—emergency treatment to restart your heart and lungs if your heartbeat or breathing stops.
• Medical Orders for Life-Sustaining Treatment (MOLST) are one way of documenting a patient’s treatment preferences concerning life-sustaining treatment.

A Health Care Agent’s Rights and Obligations Under New York’s Health Care Proxy Law

• Your health care agent will only have the authority to make decisions related to artificial nutrition and hydration (e.g., use of a tube to give you food and water) if you have communicated your wishes to him or her. You may either tell your agent or write about your wishes in your health care proxy form.
• Your agent will have the authority to decide whether your heartbeat should be restarted through cardiopulmonary resuscitation (CPR), unless you specify in your health care proxy that your agent cannot make this decision for you.
• Once your agent’s authority begins, he or she has the right to get your medical information and records to make informed health care decisions for you.
• Your agent’s decision is final unless an objecting family member or facility obtains a court order overriding the decision or disqualifying the agent.
• Your agent is not financially responsible for the cost of your care.
• Overall, your agent is required to make health care decisions for you according to your wishes, religious and moral beliefs, and in your best interest.

Advance Care Planning and Advance Directives FAQ

What is advance care planning?

This is the process of talking about and writing down your wishes for medical care if you become unable to speak for yourself.

What is an advance directive?

An advance directive is written instructions about health care treatment made by adult patients before they lose decision-making capacity. An advance directive may include a:

• health care proxy form,
• nonhospital order not to resuscitate (DNR), and/or
• Medical Orders for Life-Sustaining Treatment (MOLST).

Who is advance care planning for?

Advance care planning is for anyone over age 18. It is important your family and loved ones know your wishes if you become unable to make health care decisions for yourself.

What is a health care agent?

A health care agent is someone you trust and choose to make health care decisions for you if you become unable to make your own decisions.

What is a health care proxy?

A heath care proxy is a document you use to appoint your health care agent.

Who should have a health care proxy?

Everyone older than age 18 should have a health care proxy. It should be updated every few years and during major life events, such as:

• going to college,
• entering a long-term relationship,
• getting married,
• getting divorced,
• having or adopting a child,
• receiving a medical diagnosis,
• planning a major trip, or
• after a change in health care or medical status (positive or negative).

Who can be a witness for the health care proxy?

Anyone over age 18, except for the person appointed as the health care agent, can be a witness.

What if I don’t appoint a health care agent?

If you don’t appoint a health care agent and you lose capacity to make decisions for yourself, a surrogate will be chosen from the surrogate list set forth in the Family Health Care Decisions Act. A surrogate, in order of highest priority, may be a:

• spouse, if not legally separated from the patient, or domestic partner;
• adult children, with consensus;
• parent(s);
• adult siblings, with consensus; or
• close friend.

What is a living will?

A living will is a written statement of your specific health care wishes in the event you become unable to decide for yourself.

New York State does not have a standard living will form. New York State does recognize living wills as valid if they provide clear and convincing evidence of the person’s wishes.

If there are any questions, don’t hesitate to ask for an Ethics consult.