Advance Health Care Directive in California: What to Include

Robert E. Williams, Attorney at Law · Updated October 4, 2026 · 6 min read

If a serious illness or accident left you unable to speak for yourself, who would make medical decisions for you, and how would they know what you want? In California, the answer is an advance health care directive. It is one of the most important documents in any estate plan, and one of the easiest to put in place.

This guide explains what an advance health care directive does, what it should include, how to sign it correctly under California law, and how it works with other documents such as a POLST form and a HIPAA authorization.

What Is an Advance Health Care Directive?

California's Health Care Decisions Law (Probate Code sections 4600 and following) allows any adult with capacity to give instructions about future health care and to appoint someone to make health care decisions if they cannot. The resulting document is called an advance health care directive. Older documents, such as a Durable Power of Attorney for Health Care or a "living will" signed under prior law, generally remain valid, but most people now use the current form.

A typical directive has several parts, following the optional statutory form in Probate Code section 4701:

• Power of attorney for health care, naming your agent and alternates.
• Instructions for health care, including end-of-life wishes and pain relief.
• Donation of organs at death, if you wish to make an anatomical gift.
• Primary physician, if you wish to name one.

Choosing a Health Care Agent

Your agent will speak for you with doctors and hospitals if you cannot. Choose someone who:

• Knows your values and will honor your wishes even if they personally disagree.
• Can stay calm and make decisions under stress.
• Is reachable quickly, ideally living nearby or willing to travel.
• Is willing to serve. Always ask first.

Name at least one alternate. California law generally prohibits your supervising health care provider, or an employee of the facility where you receive care, from serving as your agent unless they are related to you or are a co-worker (Probate Code section 4659).

What Powers Does the Agent Have?

Unless you limit them, your agent can consent to or refuse any medical care, including life-sustaining treatment; choose doctors and facilities; access your medical records; authorize an autopsy; and direct disposition of your remains. Your agent's authority usually begins when your primary physician determines that you lack capacity to make your own health care decisions, although you may choose to make it effective immediately.

Stating Your Treatment Wishes

The instructions section is where you tell your agent and doctors what matters to you. You might address:

• Whether you want life-prolonging treatment if you have an incurable and irreversible condition that will result in death within a relatively short time.
• Your wishes if you become permanently unconscious.
• Whether you want artificial nutrition and hydration.
• Your preferences about pain relief, even if it might hasten death.
• Religious or personal values that should guide decisions.
• Where you would prefer to spend your final days, such as at home.

It is often more helpful to describe your values ("I want to be able to recognize my family," or "I want every possible treatment as long as there is a chance of recovery") than to try to anticipate every medical scenario.

Organ and Tissue Donation

The directive can record your decision to donate organs, tissues or your whole body after death, and for which purposes (transplant, therapy, research or education). This works alongside registering with the Donate Life California registry, which many Californians do when they renew a driver's license. For more on why this matters, read the client letter Donate Life: Organ Donation.

Signing Requirements

To be legally sufficient in California, the directive must be signed and dated by you (or by another adult at your direction) and must be either acknowledged before a notary public or signed by two qualified adult witnesses (Probate Code section 4673).

The witnesses must personally know you or have identity proven to them, and must sign that you appeared to be of sound mind and not under duress. Certain people cannot be witnesses: your agent, your health care provider or an employee of your provider, and the operator or an employee of a residential care facility for the elderly or community care facility. In addition, at least one of the two witnesses must not be related to you by blood, marriage or adoption and must not be entitled to any part of your estate (Probate Code section 4674).

Special rule for nursing homes: if you are a patient in a skilled nursing facility when you sign, a patient advocate or ombudsman designated by the State Department of Aging must sign as a witness, in addition to the other requirements (Probate Code section 4675).

Related Documents

HIPAA authorization

Federal privacy rules can make it hard for family members to get information from doctors. A separate HIPAA authorization lets the people you name receive your medical information even before your agent's decision-making authority begins.

POLST

A Physician Orders for Life-Sustaining Treatment (POLST) form is a medical order signed by you and your physician, nurse practitioner or physician assistant. It is meant for people with serious illness or frailty and tells emergency personnel what to do right now, for example whether to attempt CPR. A POLST does not replace an advance directive; the two work together.

Financial power of attorney

Health care and financial decisions are separate. Your health care agent has no authority over your bank accounts. For that, you need a durable power of attorney for finances and, often, a revocable living trust.

Registering and Sharing Your Directive

A directive only helps if people can find it. Give copies to your agent and alternates, your primary physician and the hospital where you usually receive care. Keep the original somewhere accessible, not in a safe deposit box that no one can open on a weekend. The California Secretary of State maintains an Advance Health Care Directive Registry where you can file notice that your document exists.

Updating or Revoking

You may revoke your designation of an agent only by a signed writing or by personally informing your supervising health care provider; other parts of the directive can be revoked in any manner that communicates your intent (Probate Code section 4695). A later directive revokes an earlier one to the extent of any conflict. If you name your spouse as agent and later divorce, that designation is generally revoked automatically. Review your directive every few years, after a major diagnosis, and whenever your choice of agent changes.

Talk About It

The conversation matters as much as the paperwork. Sit down with your agent, explain what you have written and why, and talk with your doctor about how your wishes apply to your health. Family disagreements at the hospital are far less likely when everyone has heard your wishes directly from you.

Conclusion

An advance health care directive puts you in charge of your own care, even when you cannot speak for yourself. Choose an agent you trust, describe your values clearly, sign the document with a notary or two qualified witnesses, and make sure the people who need it have a copy. Along with a HIPAA authorization, a financial power of attorney and a will or trust, it completes the foundation of a sound California estate plan.

Related Articles

• Durable Power of Attorney for Finances in California
• Will vs. Living Trust in California: Which One Do You Need?
• Special Needs Trusts in California: Protecting SSI and Medi-Cal

This article provides general information about California and federal law as of October 4, 2026. It is not legal advice and does not create an attorney–client relationship.