An adult having capacity may give an individual health care instruction. The individual instruction may be oral or written. The individual instruction may be limited to take effect only if a specified condition arises.
Advance Health Care DirectivesGeneral Provisions
Section § 4670
Adults who are mentally capable can make their own health care instructions, which can be spoken or written. These instructions can be set to apply only under certain conditions.
health care instruction capacity oral instruction
Section § 4671
This law allows capable adults to create a power of attorney for health care, letting someone they trust make medical decisions for them. The person they choose, called an agent, can also be given permission to handle personal care matters like deciding on living arrangements, meals, hiring help, transportation, mail, and leisure activities.
(a)CA Probate Code § 4671(a) An adult having capacity may execute a power of attorney for health care, as provided in Article 2 (commencing with Section 4680). The power of attorney for health care may authorize the agent to make health care decisions and may also include individual health care instructions.
(b)CA Probate Code § 4671(b) The principal in a power of attorney for health care may grant authority to make decisions relating to the personal care of the principal, including, but not limited to, determining where the principal will live, providing meals, hiring household employees, providing transportation, handling mail, and arranging recreation and entertainment.
power of attorney for health care health care decisions agent authority
Section § 4672
This law allows a person to include their choice for a conservator or guardian in their advance health care directive. If a court process is started to protect the person's health or finances, the court will consider the person's nomination. If these proceedings happen in California, the most recent nomination will be respected, even if it's not in the advance health care directive, as long as it meets certain rules set out in another law called Section 1810.
(a)CA Probate Code § 4672(a) A written advance health care directive may include the individual’s nomination of a conservator of the person or estate or both, or a guardian of the person or estate or both, for consideration by the court if protective proceedings for the individual’s person or estate are thereafter commenced.
(b)CA Probate Code § 4672(b) If the protective proceedings are conservatorship proceedings in this state, the nomination has the effect provided in Section 1810 and the court shall give effect to the most recent writing executed in accordance with Section 1810, whether or not the writing is a written advance health care directive.
advance health care directive nomination of conservator guardian nomination
Section § 4673
This law says that for a written advance health care directive to be legally valid, it needs to have a date, be signed by the patient or someone they choose in front of them, and be either notarized or witnessed by two eligible people. If the directive is in electronic form, it must be notarized and can use a digital signature that meets specific technical standards. The digital signature should be unique, verifiable, under the user's sole control, linked to the unchangeable data in the document, and tied to a digital certificate.
(a)CA Probate Code § 4673(a) A written advance health care directive is legally sufficient if all of the following requirements are satisfied:
(1)CA Probate Code § 4673(a)(1) The advance directive contains the date of its execution.
(2)CA Probate Code § 4673(a)(2) The advance directive is signed either by the patient or in the patient’s name by another adult in the patient’s presence and at the patient’s direction.
(3)CA Probate Code § 4673(a)(3) The advance directive is either acknowledged before a notary public or signed by at least two witnesses who satisfy the requirements of Sections 4674 and 4675.
(b)CA Probate Code § 4673(b) An electronic advance health care directive or power of attorney for health care is legally sufficient if the requirements in subdivision (a) are satisfied, except that for the purposes of paragraph (3) of subdivision (a), an acknowledgment before a notary public shall be required, and if a digital signature is used, it meets all of the following requirements:
(1)CA Probate Code § 4673(b)(1) The digital signature either meets the requirements of Section 16.5 of the Government Code and Chapter 10 (commencing with Section 22000) of Division 7 of Title 2 of the California Code of Regulations or the digital signature uses an algorithm approved by the National Institute of Standards and Technology.
(2)CA Probate Code § 4673(b)(2) The digital signature is unique to the person using it.
(3)CA Probate Code § 4673(b)(3) The digital signature is capable of verification.
(4)CA Probate Code § 4673(b)(4) The digital signature is under the sole control of the person using it.
(5)CA Probate Code § 4673(b)(5) The digital signature is linked to data in such a manner that if the data are changed, the digital signature is invalidated.
(6)CA Probate Code § 4673(b)(6) The digital signature persists with the document and not by association in separate files.
(7)CA Probate Code § 4673(b)(7) The digital signature is bound to a digital certificate.
advance health care directive written directive requirements electronic directive
Section § 4674
If you have a written advance health care directive, the document needs to be signed by witnesses who meet certain requirements. These witnesses must be adults and can either witness the patient signing the document or the patient acknowledging it. Certain people, like health care providers, their employees, and operators or employees of care facilities, cannot be witnesses.
The witnesses must declare that the person signing the document is known to them or has proven their identity, signed willingly, and is of sound mind. Additionally, one witness must not be related to the patient or entitled to any part of the patient's estate. However, if the document is acknowledged before a notary public, these witness requirements don't apply.
If the written advance health care directive is signed by witnesses, as provided in Section 4673, the following requirements shall be satisfied:
(a)CA Probate Code § 4674(a) The witnesses shall be adults.
(b)CA Probate Code § 4674(b) Each witness signing the advance directive shall witness either the signing of the advance directive by the patient or the patient’s acknowledgment of the signature or the advance directive.
(c)CA Probate Code § 4674(c) None of the following persons may act as a witness:
(1)CA Probate Code § 4674(c)(1) The patient’s health care provider or an employee of the patient’s health care provider.
(2)CA Probate Code § 4674(c)(2) The operator or an employee of a community care facility.
(3)CA Probate Code § 4674(c)(3) The operator or an employee of a residential care facility for the elderly.
(4)CA Probate Code § 4674(c)(4) The agent, where the advance directive is a power of attorney for health care.
(d)CA Probate Code § 4674(d) Each witness shall make the following declaration in substance:
“I declare under penalty of perjury under the laws of California (1) that the individual who signed or acknowledged this advance health care directive is personally known to me, or that the individual’s identity was proven to me by convincing evidence, (2) that the individual signed or acknowledged this advance directive in my presence, (3) that the individual appears to be of sound mind and under no duress, fraud, or undue influence, (4) that I am not a person appointed as agent by this advance directive, and (5) that I am not the individual’s health care provider, an employee of the individual’s health care provider, the operator of a community care facility, an employee of an operator of a community care facility, the operator of a residential care facility for the elderly, nor an employee of an operator of a residential care facility for the elderly.”
(e)CA Probate Code § 4674(e) At least one of the witnesses shall be an individual who is neither related to the patient by blood, marriage, or adoption, nor entitled to any portion of the patient’s estate upon the patient’s death under a will existing when the advance directive is executed or by operation of law then existing.
(f)CA Probate Code § 4674(f) The witness satisfying the requirement of subdivision (e) shall also sign the following declaration in substance:
“I further declare under penalty of perjury under the laws of California that I am not related to the individual executing this advance health care directive by blood, marriage, or adoption, and, to the best of my knowledge, I am not entitled to any part of the individual’s estate upon his or her death under a will now existing or by operation of law.”
(g)CA Probate Code § 4674(g) The provisions of this section applicable to witnesses do not apply to a notary public before whom an advance health care directive is acknowledged.
advance health care directive witness requirements health care directive witness
Section § 4675
If someone living in a skilled nursing facility makes an advance health care directive, it isn't valid unless a patient advocate or ombudsman signs as a witness. This person ensures the patient can make decisions voluntarily. The advocate can trust the facility's staff or the patient's family to confirm who the patient is.
(a)CA Probate Code § 4675(a) If an individual is a patient in a skilled nursing facility when a written advance health care directive is executed, the advance directive is not effective unless a patient advocate or ombudsman, as may be designated by the Department of Aging for this purpose pursuant to any other applicable provision of law, signs the advance directive as a witness, either as one of two witnesses or in addition to notarization. The patient advocate or ombudsman shall declare that he or she is serving as a witness as required by this subdivision. It is the intent of this subdivision to recognize that some patients in skilled nursing facilities are insulated from a voluntary decisionmaking role, by virtue of the custodial nature of their care, so as to require special assurance that they are capable of willfully and voluntarily executing an advance directive.
(b)CA Probate Code § 4675(b) A witness who is a patient advocate or ombudsman may rely on the representations of the administrators or staff of the skilled nursing facility, or of family members, as convincing evidence of the identity of the patient if the patient advocate or ombudsman believes that the representations provide a reasonable basis for determining the identity of the patient.
advance health care directive skilled nursing facility patient advocate
Section § 4676
This law ensures that if you create a written advance health care directive (a legal document outlining your health care wishes) in another state or place, it will be considered valid in California as long as it follows the laws there or here. Also, unless there's a reason to think otherwise, doctors and health care providers in California can assume that these directives, from here or elsewhere, are legally valid.
(a)CA Probate Code § 4676(a) A written advance health care directive or similar instrument executed in another state or jurisdiction in compliance with the laws of that state or jurisdiction or of this state, is valid and enforceable in this state to the same extent as a written advance directive validly executed in this state.
(b)CA Probate Code § 4676(b) In the absence of knowledge to the contrary, a physician or other health care provider may presume that a written advance health care directive or similar instrument, whether executed in another state or jurisdiction or in this state, is valid.
advance health care directive health care wishes cross-jurisdiction validity
Section § 4677
This law ensures that health care providers, insurance companies, and health care institutions cannot force you to sign or cancel an advance health care directive in order to receive medical care, get admitted to a facility, or obtain insurance coverage. Your right to make health care decisions through an advance directive is protected and cannot be used as a precondition for getting services.
A health care provider, health care service plan, health care institution, disability insurer, self-insured employee welfare plan, or nonprofit hospital plan or a similar insurance plan may not require or prohibit the execution or revocation of an advance health care directive as a condition for providing health care, admission to a facility, or furnishing insurance.
advance health care directive health care decisions patient rights
Section § 4678
This law states that if someone is given the authority to make health care decisions for another person, they can access the same medical information and records as the patient themselves unless the health care directive says otherwise.
Unless otherwise specified in an advance health care directive, a person then authorized to make health care decisions for a patient has the same rights as the patient to request, receive, examine, copy, and consent to the disclosure of medical or any other health care information.
advance health care directive authorized decision maker patient rights
Section § 4679
This law explains that individuals can voluntarily create a psychiatric advance directive, which is a legal document to outline their treatment preferences in case of a mental health crisis. It's intended to ensure that people with mental illness can plan their care, promoting autonomy and collaboration with healthcare providers. The law encourages using such directives because they can improve outcomes, empower patients, and enhance medication adherence. Including specific reasons for treatment preferences in these directives is beneficial. These preferences, while not formal instructions, offer valuable insight into an individual’s mental health care needs.
(a)Copy CA Probate Code § 4679(a)
(1)Copy CA Probate Code § 4679(a)(1) This chapter does not prohibit the execution of a voluntary standalone
psychiatric advance directive.
(2)CA Probate Code § 4679(a)(2) As used in this chapter, “psychiatric advance directive” means a legal document, executed on a voluntary basis by a person who has the capacity to make medical decisions and in accordance with the requirements for an advance health care directive in this division, that allows a person with mental illness to protect their autonomy and ability to direct their own care by documenting their preferences for treatment in advance of a mental health crisis.
(b)CA Probate Code § 4679(b) It is the intent of the Legislature to promote the use of a psychiatric advance directive, subject to the requirements of this division, by a person who wants to make sure their health care providers know their treatment preferences in the event of a future mental health
crisis.
(c)CA Probate Code § 4679(c) The Legislature finds and declares all of the following:
(1)CA Probate Code § 4679(c)(1) Research has demonstrated that the use of psychiatric advance directives improves collaboration, which improves outcomes, increases empowerment, and improves medication adherence.
(2)CA Probate Code § 4679(c)(2) A psychiatric advance directive is most helpful when it includes reasons for preferring or opposing specific types of treatment.
(3)CA Probate Code § 4679(c)(3) Mental health preferences that do not constitute health care instructions or decisions as defined in this part may provide valuable information to improve an individual’s mental health care.
psychiatric advance directive mental health crisis treatment preferences
