Planning

The Advance Health Care Directive is a legally binding form that lets you exercise your right to give instructions about your own health care and/or to name someone else to make health care decisions for you in the event you are unable to speak for yourself. If you use this form, you may complete or modify all or any part of it. You are free to use a different form. In any case, agents designated and signatures required must be done in the manner prescribed on this form and mandated by the California State Legislature.

It is recommended that you use this form and complete the whole form. Completing this form will revoke any previous health care directives. It is advisable to also complete the Values Checklist we provide and include that as an attachment to your Advance Directive to help clarify your wishes.

Equally important is having meaningful conversations with people who care about you so that they know and understand your wishes concerning end of life care. Guidelines to help Talking Things Over are provided on this site to help you through the process.

Upon completion of your Advance Healthcare Directive, copies should be distributed to family members and those who would care for you in the event of a life-threatening condition. It is also recommended that you keep a current copy of your Advance Directive in the glove box of your vehicle.

PDF format

Download Advance Healthcare Directive in PDF format. (You need the free Acrobat Reader to open and print this file.)

en Espanol

Download Advance Healthcare Directive in Spanish

This important study and related reports released by the California Healthcare Foundation in March 16, 2007 reports that: In California, the most populous and diverse state in the country, significant racial and ethnic differences exist at the end of life. These reports – the first in a new series of CHCF-supported projects focusing on end-of-life issues - found significant variations in the expectations, experiences, and decisions of patients and their families in the months preceding death.

“As California’s diverse population grows older, ensuring quality care at the end of life for everyone takes on even greater significance,” Mark D. Smith, M.D., M.B.A., president and CEO of CHCF, said Thursday at the Association of Health Care Journalists conference in Los Angeles. “By supporting research and projects to improve the quality of end-of-life care, CHCF sees an opportunity to help make California a national example of best medical practices and culturally appropriate care.”

Case studies provide a way for us to analyze and think-through difficult medical and moral situations. This Center for Practical Bioethics webpage links you to stories that will challenge you to think clearly as you consider options at the crossroads of decision.

[Five Wishes — Advance Directive Workbook]

2000 Envejecimiento con Dignidad Spanish language version of the popular guide to completing advance directives. Funded by Robert Wood Johnson Foundation.

Obtain from: Aging with Dignity $1 if ordering 25 or more.

A gressroots project to improve end of life care, this film sheds light on the 21st century American struggle with communication and preparation at the end-of-life. Throughout the film, there are intimate accounts of the emotional, spiritual, physical and social burdens associated with the historical shift that has occurred with dying. Forty years ago, most people experienced a quick death, but today we are more likely to suffer a slow, incremental dying process.

Consider the Conversation examines multiple perspectives on end-of-life care and includes information and experiences gathered from interviews with patients, family members, doctors, nurses, clergy, social workers, and national experts on death and dying. The film includes in-depth interviews with 40+ individuals from California, Illinois, Indiana, New Hampshire, Massachusetts, New York, Vermont and Wisconsin. 62 “person on the street” interviews were also conducted in New York City in April of 2010.