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Navigating the Seas of Healthcare: A Comprehensive Guide to Advanced Healthcare Directives in California

Posted by James Burns | Nov 28, 2023 | 0 Comments



In the intricate tapestry of estate planning, one often encounters terms like "Advanced Healthcare Directive," "Living Will," and the enigmatic "HIPAA disclosure." These legal instruments may sound formidable, but fret not, dear reader, for we are about to embark on a genteel exploration of their significance in the California healthcare landscape.


The Symphony of Healthcare Documents:


1. Advanced Healthcare Directive (AHCD):


Picture an Advanced Healthcare Directive as your personal conductor in the symphony of medical decisions, gracefully guided by California Probate Code Sections 4600-4806. This elegant document bestows authority upon an agent of your choosing to make healthcare decisions on your behalf, in accordance with your expressed wishes.


   Key Points:


     - It bestows authority upon an agent of your choosing to make healthcare decisions on your behalf.


     - Specifies your desires regarding life-sustaining treatments and organ donation.


     - Offers clarity on your end-of-life preferences, ensuring your values reverberate even when you cannot articulate them.


  Distinguished from Living Will:


     - While an AHCD covers a broader spectrum of healthcare decisions, a Living Will predominantly addresses end-of-life choices.


     - The former appoints an agent, a trusted confidant, to guide the ship, whereas the latter is a direct communication of your wishes.


2. Living Will:


   Think of the Living Will as the poetic verse in the estate planning sonnet, expressing your desires when twilight descends. While not exclusive to California, it dovetails with the Advanced Healthcare Directive, adding a nuanced layer to your healthcare narrative.



  Key Points:


     - Articulates your preferences for medical interventions, especially those related to life-prolonging treatments.


     - Often contains specific scenarios, like the use of ventilators or resuscitation, allowing you to compose a bespoke anthem of your values.


   Distinguished from AHCD:


     - A Living Will is akin to a soliloquy, directly addressing your medical preferences, while an AHCD appoints an agent to interpret and implement those preferences in the broader spectrum of healthcare decisions.


3. HIPAA Disclosure per Cal Civ Code 56:


   As we waltz through the corridors of privacy, the HIPAA (Health Insurance Portability and Accountability Act) Disclosure under California Civil Code 56 emerges as a guardian of your medical secrets. It grants a gracious nod to confidentiality while paving the way for the graceful dance of healthcare decision-making.


  Key Points:


     - Authorizes specific individuals, often mentioned in your AHCD, to access your medical records.


     - Acts as a chaperone for sensitive information, ensuring only those entrusted with your healthcare governance can unlock the doors of medical history.


   Integration with AHCD and Living Will:


     - The HIPAA Disclosure complements the AHCD and Living Will by ensuring that those designated to make decisions have a comprehensive understanding of your medical history.


The Ballet of Case Law:


In the illustrious theater of legal precedent, we find a few performances showcasing the indispensability of these healthcare directives.


Case of Guardianship Battles: In instances where there's a lack of clear healthcare directives, families may find themselves entangled in legal disputes over the guardianship of an incapacitated loved one. The absence of an AHCD or Living Will leaves the stage open to conjecture and familial discord.


End-of-Life Decision Challenges: Noteworthy cases highlight the challenges families face when there's ambiguity in the desires of an incapacitated individual. An AHCD and Living Will, crafted with precision, emerge as guiding beacons, sparing families the agony of making decisions in the absence of explicit directives.


Case Examples:


Terry Schiavo

Terry Schiavo was a Florida woman who suffered a severe brain injury in 1990, leaving her in a persistent vegetative state. Her husband, Michael Schiavo, became her legal guardian and sought to have her feeding tube removed, arguing that it was in accordance with her wishes. Terry's parents, however, opposed the removal of the feeding tube, believing that she would have wanted to continue living. The case became a national controversy, with intense media coverage and legal battles. In 2005, after seven years of legal battles, the feeding tube was removed, and Terry Schiavo died 13 days later. The Schiavo case highlighted the importance of having advanced healthcare directives in place to ensure that individuals' wishes are respected in the event of a medical emergency.

Cruzan v. Director, Missouri Department of Health

Nancy Cruzan was a Missouri woman who suffered a severe brain injury in 1983, leaving her in a persistent vegetative state. Her parents sought to have her feeding tube removed, arguing that it was in accordance with her wishes. However, the Missouri Supreme Court ruled that the state had a legitimate interest in preserving life and that there was insufficient evidence to establish Nancy Cruzan's wishes regarding life-prolonging treatment. The case was appealed to the U.S. Supreme Court, which upheld the Missouri Supreme Court's decision in a 5-4 ruling. The Cruzan case established that states have the authority to require clear and convincing evidence of a patient's wishes before removing life-prolonging treatment.

Conservatorship of Haskins

Barbara Haskins was a California woman who suffered a severe brain injury in 1984, leaving her in a persistent vegetative state. Her two sons, who were appointed her co-conservators, disagreed about whether to continue providing her with life-sustaining treatment. One son sought to remove her feeding tube, while the other argued that it should remain in place. The case went to trial, and a judge ruled in favor of the son who wanted to remove the feeding tube. However, the California Supreme Court overturned the trial court's decision, holding that the co-conservators were deadlocked and that the feeding tube could not be removed without a consensus. The Haskins case underscored the importance of clear communication and consensus among family members when making healthcare decisions for an incapacitated loved one.

These cases provide valuable insights into the challenges and complexities that arise when an individual does not have an advanced healthcare directive in place. Having an AHCD in place can help ensure that an individual's wishes are respected and that their loved ones are not left to make difficult decisions in the midst of a medical emergency.



As we draw the curtains on this discourse, let us appreciate the importance of these healthcare directives in orchestrating a harmonious estate plan. In California, the Advanced Healthcare Directive, Living Will, and HIPAA Disclosure pirouette together, ensuring your healthcare legacy is penned with dignity and respect. By embracing these genteel legal instruments, you not only grant yourself peace of mind but gift your loved ones the grace of knowing and respecting your wishes, even when words fail.


So, dear reader, may your estate plan be as refined as a cup of Earl Grey, steeped in the nuances of your desires and elegantly navigating the complexities of healthcare decision-making.

About the Author

James Burns

Estate Planning, Asset Protection, Business and Real Estate Transactions, nutraceutical Law and franchising:


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