In Pennsylvania, competent adults have the right to decide whether to accept, reject, or discontinue medical care and treatment. For example, if your health care provider recommends a course of treatment, you have the right to decline that course of treatment.

There may be times, however, when you cannot communicate medical decisions to your health care provider or you cannot make your wishes known to your health care provider. For example, you might be unconscious or suffer from dementia. So, how do you make your wishes known to your health care providers and family? And, who makes medical decisions for you when you are unable to make your own decisions? In Pennsylvania, you can use an advance directive both to provide guidance to health care providers and family regarding the type of medical care you want and to appoint a surrogate decision maker to make medical decisions for you if you become unable to make your own decisions.

1. What is an advance directive?

2. What types of advance directives does Pennsylvania recognize?

3. Can I have both a living will and health care power of attorney?

4. Who can make an advance directive?

5. How do I make an advance directive?

6. Does my advance directive have to be notarized?

7. Who should have a copy of my advance directive?

8. Am I required to have an advance directive?

9. What if I do not have an advance directive?

10. What is a living will?

11. When will my living will take effect?

12. What does it mean to be incompetent?

13. What is an end-stage medical condition?

14. Does my health care provider have to follow the instructions in my living will?

15. Can I change my living will?

16. What is a health care power of attorney?

17. When does a health care power of attorney take effect?

18. What does it mean to be incompetent?

19. Who can I appoint to make medical decisions for me? Can I appoint more than one decision maker?

20. What medical decisions can my decision maker make?

21. Can I change my health care power of attorney?

22. What is a health care representative?

23. What does it mean to be incompetent?

24. What medical decisions can my health care representative make?

25. Who can be my health care representative?

26. Can I have more than one health care representative?

27. So, if I have a current spouse and two adult children from another marriage, my current spouse and my two adult children all make medical decisions for me?

28. What if my health care representatives cannot agree to a decision regarding my care?

29. What are the main differences between a living will and a health care power of attorney?

30. If the law appoints a health care representative, why would I need an advance directive?

31. Does Pennsylvania recognize advance directives from other states?

32. Do other states recognize advance directives from Pennsylvania?

1. What is an advance directive?

2. What types of advance directives does Pennsylvania recognize?

Two. Pennsylvania recognizes two types of advance directives: a living will and a health care power of attorney. Each type of advance directive serves a different function.  back to top

3. Can I have both a living will and health care power of attorney?

Yes. Since both a living will and health care power of attorney serve different functions, it is recommended that you have both a living will and health care power of attorney. The sample form available for download is a both a living will and health care power of attorney.  back to top

4. Who can make an advance directive?

Any person of sound mind who is: (1) at least 18 years old; (2) a high school graduate; (3) married; or (4) emancipated may make an advance directive.  back to top

5. How do I make an advance directive?

An advance directive must be written. In addition, the following requirements must be met:

(a) You must sign the advance directive. If you are unable to sign the document, you may direct someone else to sign it on your behalf.

(b) It must be witnessed by two people over the age of 18. If someone signed your advance directive on your behalf, that person cannot be a witness.  back to top

6. Does my advance directive have to be notarized?

No. Pennsylvania does not require that advance directives be notarized. However, if you anticipate using your advance directive in another state, it is recommended that the advance directive be notarized.  back to top

7. Who should have a copy of my advance directive?

It is recommended that you give a copy of your advance directive to your family physician, your hospital, and members of your family. You should also keep a copy for your records. When you give a copy of your advance directive to your physician and hospital, the advance directive becomes a part of your medical record.  back to top

8. Am I required to have an advance directive?

No. You are not required to have an advance directive.  back to top

9. What if I do not have an advance directive?

If you do not have an advance directive and you are unable to make medical decisions for yourself, Act 169 of 2006 directs health care providers to look to your health care representative. The role and appointment of a health care representative is described below.  back to top

Living Wills

10. What is a living will?

A living will allows you to express your wishes and instructions regarding the type of medical care you want or do not want when faced with end-of-life decisions. For example, a living will allows you to express your wishes regarding artificial nutrition and hydration, artificial respiration, and cardio-pulmonary resuscitation.  back to top

11. When will my living will take effect?

Your living will takes effect when the following three conditions are met:

(a) Your physician or health care provider has a copy of your living will;

(b) Your physician has determined that you are incompetent; and

(c) Your physician has determined that you are permanently unconscious or suffer from an end-stage medical condition. back to top

12. What does it mean to be incompetent?

To be incompetent means that you are unable to understand the risks and benefits of a medical decision, you cannot make a medical decision on your behalf, or you cannot communicate a medical decision to your health care provider. For example, if you are unconscious or you suffer from dementia, your health care provider likely will determine that you are incompetent. A formal adjudication of incompetency by a court is not required for your living will to take effect. back to top

13. What is an end-stage medical condition?

An end-stage medical condition is an incurable or irreversible medical condition in an advanced state that even with the introduction of medical treatment will result in death. For example, advanced Alzheimer’s disease or terminal cancer are considered end-stage medical conditions. back to top

14. Does my health care provider have to follow the instructions in my living will?

Generally, yes. Pennsylvania law requires health care providers to follow the instructions in your living will. However, there are special rules about pregnant women who have living wills. Also, a living will cannot instruct your health care provider to act contrary to Pennsylvania law. If your health care provider cannot follow your instructions because of moral beliefs, your health care provider must transfer your care to another health care provider who can follow your instructions. back to top

15. Can I change my living will?

Yes. You may revoke your living will at any time and in any manner. You can tell your health care provider that you no longer want him or her to follow the instructions in your living will. You may also draft a new living will. If you draft a new living will, it is recommended that you destroy all copies of your old living will and provide copies of the new living will to your family physician, hospital, and family. back to top

Health Care Power of Attorney

16. What is a health care power of attorney?

A health care power of attorney allows you to appoint someone to make medical decisions for you should you be unable to make medical decisions for yourself. You can also provide instructions to help your appointed decision maker make medical decisions. back to top

17. When does a health care power of attorney take effect?

A health care power attorney takes effect when the following two conditions are met:

(a) Your health care provider has a copy of your health care power of attorney; and

(b) Your health care provider determines that you are incompetent. back to top

18. What does it mean to be incompetent?

See question 12. back to top

19. Who can I appoint to make medical decisions for me? Can I appoint more than one decision maker?

You can appoint any adult person you want. It is recommended that you appoint someone who has knowledge of your values and beliefs regarding medical care. You may appoint more than one decision maker, but it is recommended that you appoint only one decision maker. You may appoint substitute decision makers if your primary decision maker is not available or does not want to serve as your decision maker. back to top

20. What medical decisions can my decision maker make?

In most cases, your appointed decision maker can make any medical decision that you could have made if you were competent. For example, your decision maker can consent to surgery, authorize your admission to a nursing home, access your medical records, consent to donation of your organs, and make end-of-life medical decisions. The health care power of attorney document allows you to limit or place restrictions on the medical decisions your decision maker can make. back to top

21. Can I change my health care power of attorney?

Yes. You can revoke your health care power of attorney by notifying your health care provider that you are revoking your health care power of attorney. You can also change your health care power of attorney by drafting a new health care power of attorney. If you draft a new health care power of attorney, you should destroy all copies of your old health care power of attorney and provide copies of your new health care power of attorney to your family physician, hospital, and family members. back to top

Health Care Representatives

22. What is a health care representative?

A health care representative is a person authorized by Act 169 of 2006 to make medical decisions for you if you do not have an advance directive and your physician determines that you are incompetent.back to top

23. What does it mean to be incompetent?

See question 12. back to top

24. What medical decisions can my health care representative make?

Generally, the medical decisions your health care representative can make are the same as the decisions an appointed decision maker can make under a health care power of attorney. That means your health care representative can consent to surgery, authorize your admission to a nursing home, access your medical records, and consent to donation of your organs. back to top

25. Who can be my health care representative?

Act 169 of 2006 provides a list of persons who can serve as your health care representative. The following persons, in the order listed, can be your health care representative:

(a) Spouse and, if applicable, your adult children from a prior relationship;

(b) Adult children;

(c) Parents;

(d) Adult siblings;

(e) Adult grandchildren; and

(f) Any adult who has knowledge of your values and beliefs (e.g. close friend, cousin, roommate) back to top

26. Can I have more than one health care representative?

Yes. All members of the same class can act as your health care representative. For example, if you do not have a current spouse, but you have three adult children, all three adult children can act as your health care representative. back to top

27. So, if I have a current spouse and two adult children from another marriage, my current spouse and my two adult children all make medical decisions for me?

Yes. According to the list in Act 169 of 2006, your current spouse and your two adult children from the prior marriage are authorized to make medical decisions for you. This is one reason why you may want to consider having an advance directive. back to top

28. What if my health care representatives cannot agree to a decision regarding my care?

Act 169 of 2006 allows health care providers to follow the instructions of the majority of your health care representatives. For example, if you have three adult children who are acting as your health care representative and they cannot agree on a medical decision, the health care provider will follow the majority decision. back to top

Miscellaneous

29. What are the main differences between a living will and a health care power of attorney?

A living will and health care power of attorney serve different functions. First, a living will is more limited in scope than a health care power of attorney. A living will only applies to medical care and decisions regarding end-of-life care. A health care power of attorney is broader in scope as it applies to all medical care and treatment. Second, a health care power of attorney allows you to appoint a decision maker to make medical decisions on your behalf. A living will generally does not appoint anyone to make medical decisions for you. Rather, you provide instructions to your health care provider regarding end-of-life care. Third, a health care power of attorney takes effect when you are incompetent while a living will does not take effect until you are both incompetent and permanently unconscious or suffer from an end-stage medical condition. back to top

30. If the law appoints a health care representative, why would I need an advance directive?

There are many reasons why an advance directive is preferable to a health care representative. First, with a health care power of attorney, you can personally appoint who you want to make medical decisions for you. For example, if you only want one of your children to make medical decisions for you, then you should have a health care power of attorney; otherwise, all of you children will make medical decisions for you. Second, a living will affords you the opportunity to express your wishes and instructions regarding end-of-life medical care. If you do not have a living will, your health care representative may not know what your wishes, values, and beliefs are regarding end-of-life medical care. back to top

31. Does Pennsylvania recognize advance directives from other states?

Generally, yes. As long as the instructions in your advance directive are not contrary to Pennsylvania law, your advance directive from another state is valid in Pennsylvania. back to top

32. Do other states recognize advance directives from Pennsylvania?

Likely, yes. However, you should check the law of the other state to be sure that the state recognizes out of state advance directives. back to top

33. Is a health care power of attorney the same as a financial power of attorney?

No. A health care power of attorney is specifically limited to medical care and treatment. Typically, a financial power of attorney does not authorize the appointed individual to make medical decisions. back to top

34. Do I have to go to an attorney to draft an advance directive?

No. Act 169 of 2006 provides a living will-health care power of attorney combined document. This document should be sufficient for most people. However, if you have specific requests or limitations you want to impose, you may want to consult an attorney to make sure your requests are accurately reflected in the advance directive. The Pennsylvania standardized document can be printed using the link below. back to top

35. I have an advance directive written before the new advance directive law. Is this advance directive still valid?

Yes. Advance directives written prior to the changes to the advance directive law are still valid. Although, it is recommended that you review your advance directive to make sure it still accurately reflects your wishes regarding the medical care. back to top

36. Where can I get more information regarding advance directives?

If you are admitted to Lancaster General Hospital, LGH staff can provide you with more information. Also, to following organizations are available for you to contact: