California Advance Health Care Directives: A Complete Guide

Why an advance health care directive matters

An advance health care directive lets you decide now who will make medical decisions for you, and what treatment you want, if you ever cannot speak for yourself. In California it requires no lawyer and no court, and it can be completed in an hour. It is one of the most important documents any adult can sign.

Without a directive, decisions fall to whoever the hospital identifies. California now gives physicians a default list of relatives and close friends to choose from, but the person chosen may not be the one you would have picked, may not know your wishes, and may disagree with others in your family. When families cannot agree, the dispute can end up in court, often while the patient is in intensive care.

A directive does three things:

•      It names your decision-maker. Your health care agent can talk to your doctors, see your records, and consent to or refuse treatment for you.

•      It records your wishes. You can say what you want, and do not want, near the end of life, about pain relief, and about anything else that matters to you.

•      It reduces conflict. Your family does not have to guess, and your doctors know whose voice carries your authority.

This guide explains California's Health Care Decisions Law, Probate Code sections 4600 through 4806: how to make a valid directive, who can and cannot be your agent, how doctors must respond, and how the directive works alongside a POLST, a HIPAA authorization, and a financial power of attorney.

The legal framework and key terms

California's Health Care Decisions Law is Division 4.7 of the Probate Code, beginning at section 4600. It replaced the older "Durable Power of Attorney for Health Care" and "Natural Death Act" documents in 2000, but directives signed under those earlier laws generally remain valid.

Term	Meaning	Statute
Advance health care directive	Either an individual health care instruction or a power of attorney for health care, or both in one document	§ 4605
Power of attorney for health care	A written document naming an agent to make health care decisions for you	§ 4629
Individual health care instruction	Your own written or oral direction about a health care decision	§ 4623
Agent	The person you name to make health care decisions for you	§ 4607
Surrogate	An adult, other than your agent or conservator, authorized to decide for you, either because you named them orally at the hospital or because the provider selected them	§§ 4643, 4711, 4712
Capacity	The ability to understand the nature and consequences of a decision, including its significant benefits, risks, and alternatives, and to make and communicate a decision	§ 4609
Primary physician	The physician you or your agent designate, or if none, the physician who takes responsibility for your care	§ 4631

What counts as a "health care decision." Section 4617 defines it broadly: choosing and discharging doctors and facilities; approving or refusing tests, surgery, and medications, including for mental health conditions; and directing that artificial nutrition and hydration, cardiopulmonary resuscitation, and all other forms of care be provided, withheld, or withdrawn. Amendments effective January 1, 2024 (AB 1029) made explicit that directives cover mental health care as well as physical health care.

Decisions no agent can make. Under Probate Code section 4652, no agent, conservator, or surrogate can consent on your behalf to commitment to a mental health facility, convulsive (electroconvulsive) treatment, psychosurgery, sterilization, or abortion. Those decisions are governed by separate laws.

Capacity is presumed. Every adult patient is presumed to have the capacity to make health care decisions and to sign or revoke a directive (§ 4657). Anyone who claims otherwise has the burden of proving it.

Choosing your health care agent

The agent is the heart of the directive. Written instructions can never anticipate every situation; an agent can respond to the actual diagnosis, the actual options, and the doctors in the room.

Who should serve. Choose someone who:

•      knows your values and will honor them even when they differ from their own;

•      can make hard decisions under stress and stand firm with doctors and relatives;

•      is likely to be reachable quickly, by phone if not in person;

•      has agreed to serve after a real conversation about your wishes.

Who cannot serve. Probate Code section 4659 disqualifies:

•      your supervising health care provider;

•      an employee of the health care institution where you are receiving care;

•      the operator or an employee of a community care facility or residential care facility for the elderly where you are receiving care.

The employee and operator rules do not apply to someone related to you by blood, marriage, or adoption, a registered domestic partner, or a coworker at the same institution. Your supervising provider can never be your agent.

Alternates. Name at least one alternate agent, to serve if your first choice is unwilling, unable, or not reasonably available. A hospital will not wait long to reach an agent in an emergency.

One agent at a time. The statutory form names one agent at a time, with alternates in order. Naming two people to act jointly is a poor fit for health care. Medical decisions often must be made quickly, and two agents who disagree can stall care. A clearer approach is one agent, with alternates in order, and an instruction that the agent consult named family members.

What your agent can decide. Unless you limit the authority, your agent can make any health care decision you could make yourself (§ 4683), including:

•      consenting to or refusing any treatment, including life-sustaining treatment, CPR, and artificial nutrition and hydration;

•      choosing and discharging doctors, hospitals, and other providers;

•      reviewing your medical records and authorizing their release, with the same rights you have (§ 4678);

•      after your death, making an anatomical gift, authorizing an autopsy, and directing the disposition of your remains.

You may also give your agent authority over personal care, such as where you will live, meals, household help, transportation, and handling your mail (§ 4671(b)).

How your agent must decide. The agent must follow your instructions and other wishes to the extent the agent knows them. When your wishes are unknown, the agent must decide in your best interest, considering your personal values (§ 4684). An agent who acts in good faith is not liable for those decisions (§ 4741).

Your agent's priority. An agent known to the provider to be reasonably available and willing to act has priority over anyone else, including your spouse and family (§ 4685). The one exception: a surrogate you name orally to your supervising provider during a hospital stay has priority over the agent for that stay or 60 days, whichever is shorter (§ 4711(d)).

Writing your health care instructions

The instructions part of a directive tells your agent and your doctors what you want. It can be as brief as one choice about life support or as detailed as several pages about your values. An individual instruction can also be limited to take effect only if a specified condition arises (§ 4670).

End-of-life choices. The statutory form (§ 4701) asks you to choose between two statements that apply if you have an incurable and irreversible condition that will result in death within a relatively short time, if you become unconscious and are unlikely to regain consciousness, or if the burdens of treatment would outweigh the benefits:

•      Choice not to prolong life. You do not want your life prolonged in those circumstances.

•      Choice to prolong life. You want your life prolonged as long as possible within generally accepted health care standards.

You may also leave the choice to your agent. Many people find that the most honest answer, paired with a clear description of their values.

Specific treatments. You may address particular treatments, such as CPR, a breathing machine, a feeding tube or IV fluids, dialysis, antibiotics, blood transfusions, and transfer to intensive care. A useful option is a time-limited trial: for example, "use a ventilator for up to two weeks, then stop if there is no meaningful improvement."

Relief from pain. The statutory form directs that treatment to relieve pain or discomfort be provided at all times, even if it hastens death, unless you say otherwise. If you want to stay as alert as possible, even at the cost of more pain, say so.

Mental health care. Since January 1, 2024, the statutory form addresses "physical and mental health care," and you may include instructions for treatment during a mental health crisis, such as preferred medications, facilities, and people to contact. California also recognizes a standalone psychiatric advance directive executed with the same formalities (§ 4679).

Your values, in your own words. The most useful instructions often say what matters to you rather than listing procedures:

•      what makes life worth living for you, such as recognizing family, communicating, or living without constant pain;

•      conditions you would find unacceptable;

•      religious, spiritual, or cultural beliefs that should guide care;

•      where you would prefer to spend your last days, at home, in hospice, or in a hospital;

•      people you want consulted, or kept informed.

Write carefully, then talk. Vague phrases such as "no heroic measures" mean different things to different people. Use plain words, and go over what you wrote with your agent and your doctor. The conversation matters as much as the paper.

Organ donation, your primary physician, and your remains

The statutory form includes two optional parts, and a directive can address what happens after death as well.

Donation of organs, tissues, and parts. You may give any needed organs, tissues, or parts; give only those you list; or refuse donation and forbid your agent from making a gift. You may limit a gift to transplant, therapy, research, or education. If you say nothing, your agent may make an anatomical gift for you after death under the Uniform Anatomical Gift Act (§ 4683). Registering with Donate Life California is a separate step that also records your choice.

Primary physician. You may name the physician you want to have primary responsibility for your care, and an alternate. The primary physician matters because, unless the directive says otherwise, that physician determines when you lack capacity and your agent's authority begins.

Autopsy and disposition of remains. Your agent may authorize an autopsy and direct the disposition of your remains (§ 4683). Under Health and Safety Code section 7100, an agent under a power of attorney for health care with that authority has first priority to control disposition, ahead of even a surviving spouse. If you want burial, cremation, a particular cemetery, or a religious ceremony, write it down, and say who should carry it out. The agent is generally not personally responsible for the costs unless the agent agrees to pay them or chooses arrangements that cost more than the estate can cover.

When the directive takes effect

Your own instructions apply whenever you cannot speak for yourself. Your agent's authority is different: by default, it begins only when you lose capacity.

The default rule. Unless the directive says otherwise, the agent's authority "becomes effective only on a determination that the principal lacks capacity, and ceases to be effective on a determination that the principal has recovered capacity" (§ 4682). Your primary physician makes that determination and records it in your medical record (§ 4732). Authority can switch on and off: an agent may decide for you during a week of sedation after surgery, then step back when you wake.

Immediate authority. The statutory form lets you check a box making the agent's authority effective immediately. Even then, you remain in charge. Under section 4689, the law does not let an agent make a decision if you object to it, and as long as you have capacity your own decisions control. Immediate authority is useful if you want your agent to speak with doctors, review records, and help coordinate care now, for example during a serious illness.

Medical information. Once authorized to make decisions, your agent has the same rights you have to request, receive, examine, copy, and consent to disclosure of your medical information (§ 4678). Because privacy rules can still slow things down in practice, many people also sign a separate HIPAA authorization that is effective immediately.

No expiration. Unless you set a termination date, the directive remains effective no matter how much time passes after you sign it (§ 4686). Still, review it every few years and after any major life or health change.

Signing it correctly

A written directive is legally sufficient if it meets three requirements in Probate Code section 4673:

1.     It is dated.

2.     It is signed by you, or by another adult in your presence and at your direction.

3.     It is either notarized or witnessed. Your signature must be acknowledged before a notary public, or the directive must be signed by two qualified witnesses.

Unlike a financial power of attorney, a health care directive does not need to be notarized to be widely accepted. Two qualified witnesses work just as well. Be careful in a hospital: your provider's employees are disqualified, so bring a friend or neighbor, or ask whether the hospital has a notary or volunteer available.

Witness rules (§ 4674). Each witness must be an adult and must sign a declaration under penalty of perjury that you are personally known to the witness or proved your identity by convincing evidence, that you signed or acknowledged the directive in the witness's presence, and that you appear to be of sound mind and free of duress, fraud, or undue influence. These people cannot be witnesses:

•      your health care agent;

•      your health care provider or an employee of your provider;

•      the operator or an employee of a community care facility;

•      the operator or an employee of a residential care facility for the elderly.

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 under an existing will or by law. That witness signs an additional declaration saying so. A friend or neighbor who is not an heir is the usual choice. The witness rules do not apply to a notary.

Skilled nursing facilities (§ 4675). If you are a patient in a skilled nursing facility when you sign, the directive "is not effective unless a patient advocate or ombudsman" designated by the California Department of Aging signs it as a witness. This applies even if the directive is notarized: the ombudsman signs either as one of the two witnesses or in addition to the notary. The facility can put you in touch with the local Long-Term Care Ombudsman program.

Electronic directives. A directive signed electronically must be notarized, and the digital signature must meet several technical requirements (§ 4673(b)). For most people, a paper original is simpler.

The form is optional. The statutory form in section 4701 "may, but need not, be used" (§ 4700). Any document that meets the legal requirements is valid, and you may modify any part of the statutory form. CaliForms' Advance Health Care Directive (Form CF-AHCD-01) is one such form, with a notary certificate, a two-witness statement with the additional declaration, and an ombudsman page.

Directives from other states. A directive signed in another state is valid in California if it complied with the law of that state or of California when signed, and California providers may presume it is valid (§ 4676). If you move here, signing a new California directive avoids any question.

What doctors and hospitals must do

A directive is meant to work without a court. Section 4750 states that it is "effective and exercisable free of judicial intervention." The Health Care Decisions Law puts clear duties on providers and protects them when they follow the rules.

Duties of providers.

•      Record it. A provider who learns of a directive, a revocation, or a surrogate designation must promptly record it in your medical record and request a copy (§ 4731).

•      Communicate. Before carrying out a decision made for you, the provider must, if possible, tell you what was decided and who decided it (§ 4730).

•      Comply. Providers must follow your individual instructions, and decisions by your agent or surrogate, "to the same extent as if the decision had been made by the patient while having capacity" (§ 4733).

•      No conditions. A provider, health plan, or insurer may not require you to sign, or forbid you from signing, a directive as a condition of care, admission, or insurance (§ 4677).

When a provider may decline. An individual provider may decline to follow an instruction or decision for reasons of conscience. A health care institution may decline only under a written policy expressly based on reasons of conscience that was timely communicated to you or your agent (§ 4734). Any provider may decline care that is medically ineffective or contrary to generally accepted health care standards (§ 4735).

What happens next. A provider or institution that declines must promptly inform you or your agent, immediately make all reasonable efforts to help transfer you to a provider who will comply, and continue providing care until the transfer happens. Pain relief and other palliative care must continue throughout (§ 4736).

Immunity and liability.

•      A provider who acts in good faith and within generally accepted health care standards is protected from civil and criminal liability and professional discipline for following a decision made for you (§ 4740).

•      Agents and surrogates are not liable for decisions made in good faith (§ 4741).

•      A provider who intentionally violates the law is liable for $2,500 or actual damages, whichever is greater, plus attorney's fees. Anyone who forges, conceals, or destroys a directive or revocation, or coerces someone into signing one, is liable for $10,000 or actual damages, whichever is greater, plus fees (§ 4742). Doing so with intent to hasten death can be prosecuted as unlawful homicide (§ 4743).

When there is a dispute. If family members, doctors, or the agent disagree, a petition may be filed in superior court by the patient, a spouse, a relative, the agent or surrogate, a conservator, the provider, or "any other interested person or friend" (§ 4765). The court can decide whether the patient has capacity, whether the directive is in effect, and whether the agent is acting consistently with the patient's wishes or best interest, and can end an agent's authority (§ 4766).

How it fits with other documents

An advance health care directive is one piece of a complete plan. These related documents fill different gaps.

Document	What it does	Who signs	When to use it
Advance health care directive	Names your agent and states your wishes for future care	You, with a notary or two witnesses	Every adult
POLST (Physician Orders for Life-Sustaining Treatment)	A medical order about CPR, level of treatment, and artificial nutrition that emergency responders and facilities must follow now	You or your decision-maker, and a physician, or a nurse practitioner or physician assistant acting under a physician's supervision	Serious illness or frailty, when end-of-life decisions are near
HIPAA authorization	Lets named people receive your medical information, effective immediately	You	Alongside the directive, especially if the agent's authority is not immediate
Durable power of attorney for finances	Names an agent for money and property	You, with a notary (strongly recommended)	Every adult; the directive does not cover finances

A directive is not a medical order. Paramedics responding to a 911 call generally will not stop to read an advance directive. If you are seriously ill and do not want CPR or hospitalization, ask your doctor about a POLST. A POLST is not an advance directive (§ 4780). Your agent can sign one for you only once you lack capacity or the agent's authority is already in effect. Providers must follow a POLST unless the care it calls for is medically ineffective (§ 4781).

If you have no directive. California now has a default process. Under section 4712, effective January 1, 2023, decision-making authority goes first to a surrogate you named orally to your provider, then to your agent, then to a conservator or guardian. If there is none, the provider may choose an adult "who has demonstrated special care and concern for the patient," such as a spouse or domestic partner, adult child, parent, adult sibling, adult grandchild, other adult relative, or close personal friend. Picking among them is the provider's call, not yours, which is the best reason to sign a directive.

Naming a surrogate in the hospital. Even without a written directive, you can name a surrogate by personally telling your supervising provider. That designation lasts for your current course of treatment or illness, your stay in the facility, or 60 days, whichever is shortest (§ 4711). You can also disqualify anyone, including a family member, from deciding for you, by a signed writing or by telling your supervising provider (§ 4715).

Conservatorship. A directive can nominate the person you want as your conservator if a court ever has to appoint one. A good directive often makes a conservatorship of the person unnecessary.

Changing or revoking your directive

You can revoke or replace your directive at any time while you have capacity, and capacity is presumed (§ 4657). The rules differ for the agent and for everything else.

What you want to revoke	How (§ 4695)
The appointment of your agent	Only by a signed writing, or by personally telling your supervising health care provider
Any other part, such as your treatment instructions	At any time and in any manner that communicates your intent to revoke, including orally

Anyone who learns of a revocation, including a provider, agent, or surrogate, must promptly tell the supervising provider and the institution (§ 4696), and the provider must record it (§ 4731).

A newer directive controls. A later directive revokes an earlier one to the extent they conflict (§ 4698). To avoid any doubt, state in the new document that it revokes all prior directives, and collect or destroy the old copies.

Divorce. If your marriage is dissolved or annulled, the appointment of your former spouse as agent is revoked automatically. It is revived if you remarry that person (§ 4697). If you want a former spouse to remain your agent, sign a new directive after the divorce. Registered domestic partners should do the same after a partnership ends rather than rely on the automatic rule.

Objecting in the moment. Even after your agent's authority has begun, the law does not authorize the agent to make a decision you object to (§ 4689).

The Secretary of State registry. California's Secretary of State runs an Advance Health Care Directive Registry (§ 4800). You file a copy for a small, cost-based fee, and the registry releases it to your health care providers, the public guardian, or your legal representative on request. Registration is optional: failing to register does not affect a directive's validity, and registering does not make it presumptively valid or superior to another directive (§§ 4803, 4804). If you register and later revoke or replace the directive, notify the registry and register the new one (§ 4802).

Practical distribution. A directive only helps if people can find it. After signing:

•      ☐ Give copies to your agent and each alternate.

•      ☐ Give a copy to your primary physician and ask that it be scanned into your chart.

•      ☐ Upload it to your health plan's patient portal, if it offers one.

•      ☐ Keep the original where your family can find it, not in a safe deposit box.

•      ☐ Carry a wallet card naming your agent and saying where the directive is kept.

•      ☐ Bring a copy whenever you are admitted to a hospital.

Common mistakes

1.     Not having one. Most people put it off until a crisis, when capacity may already be gone.

2.     Naming an agent without talking to them. An agent who does not know your wishes cannot honor them, and one who is surprised may freeze or decline.

3.     No alternate agent. If your only agent cannot be reached, decisions fall to whoever the provider selects.

4.     Using a family member as both witnesses. At least one witness must be unrelated to you and not an heir, and your agent cannot be a witness at all.

5.     Signing in a nursing home without the ombudsman. A directive signed by a skilled nursing facility patient is not effective without a patient advocate or ombudsman as witness, even if notarized.

6.     Relying on vague phrases. "No heroic measures" or "no machines" can be read many ways. Describe outcomes you would and would not accept.

7.     Assuming the directive stops paramedics. It does not. For orders that apply in an emergency, talk with your doctor about a POLST.

8.     Locking it away. A directive in a safe deposit box or a lawyer's file is useless at 2 a.m. in an emergency room.

9.     Forgetting to update after divorce or the agent's death. A divorce revokes a former spouse's appointment automatically, which may leave no agent at all.

10.  Assuming it covers finances. It does not. Sign a durable power of attorney for finances too.

Frequently asked questions

Do I need a lawyer? No. The statutory form and well-drafted self-help forms are designed for people to complete on their own. A lawyer is helpful for complicated family situations or detailed instructions.

Does it have to be notarized? No. Two qualified witnesses are equally valid. A notary is required only for an electronically signed directive.

Can my agent override my written instructions? No. The agent must follow your instructions and known wishes, and decides by your best interest only where your wishes are unknown (§ 4684).

Can my family override my agent? No. A reasonably available and willing agent has priority over everyone else, including your spouse and children (§ 4685). The only exception is a surrogate you name yourself during a hospital stay.

Will doctors follow it? They must, unless they decline for reasons of conscience or because the care would be medically ineffective. Even then, they must help transfer you to someone who will comply and keep caring for you until the transfer (§§ 4733–4736).

Is my out-of-state directive valid in California? Generally yes, if it was valid where you signed it (§ 4676). Signing a California directive after you move avoids any questions.

Can I give my agent authority over mental health treatment? Yes. Directives may cover mental health care, and California recognizes standalone psychiatric advance directives (§ 4679). No agent can consent to commitment to a mental health facility, electroconvulsive therapy, or psychosurgery (§ 4652).

What is the difference between a directive and a living will? "Living will" is an informal name for written end-of-life instructions. In California those instructions are part of an advance health care directive.

Is my old "Durable Power of Attorney for Health Care" still valid? Generally yes, if it was valid under the law when you signed it. Review it anyway; many older forms are outdated, and a new directive is easy to sign.

When to talk to a California attorney

Most people can complete a directive on their own. Consider legal advice if:

•      you expect family members to disagree with your choices or your choice of agent;

•      you want detailed mental health, religious, or experimental-treatment instructions;

•      you live in a skilled nursing facility or have questions about your capacity;

•      you are coordinating the directive with a trust, a financial power of attorney, or a conservatorship;

•      you are an agent facing a dispute with a provider or with family.

This article is general information about California law as of October 2026, provided by CaliForms for self-help use. It is not legal or medical advice and does not create an attorney-client relationship.

Sources

•      California Probate Code (FindLaw, current as of January 1, 2026): § 4605, § 4609, § 4617, § 4652, § 4657, § 4659, § 4670–§ 4679, § 4682–§ 4690, § 4695–§ 4698, § 4700, § 4701, § 4711, § 4712, § 4715, § 4730–§ 4743, § 4750, § 4765, § 4766, § 4780, § 4781, § 4800–§ 4806

•      Health and Safety Code § 7100