Understanding Advance Directives and Medical Powers of Attorney

by Sheryll Bonilla, Esq.

An Advance Directive or Living Will is a legal document that allows individuals to outline their preferences for medical treatment in situations where they can no longer communicate their decisions.

This often includes directives about life-sustaining treatments such as mechanical ventilation or resuscitation.​

In contrast, a Medical Power of Attorney designates an agent to make healthcare decisions on behalf of the principal (the person creating the document) when they lack capacity.

The agent is expected to honor the principal’s wishes and best interests.​

While both documents serve to guide medical care, conflicts can arise, especially if the decisions of your healthcare agent conflict with the stipulations in the advance directive.​

Under Hawaii law, at Hawaii Revised Statutes Section 327E-3, these are combined into a single document to avoid both the confusion and unavailability of authority that can arise from not having them together.

HIPAA authorization is also part of the current Advance Directive, so that appointed agents have the authority to obtain information related to a person’s medical treatment.

Risks of Appointing Co-Agents

Designating multiple individuals as co-agents can lead to disputes. Conflicting opinions among co-agents can delay critical medical decisions and may result in actions that contradict the principal’s documented wishes. 

Such disagreements can also place additional emotional strain on family members during already challenging times.​

On the other hand, when co-agents are appointed, there can be more of a sense of shared responsibility and shared decision-making, so that the agents do not feel the weight of making a decision alone to let a parent go.

Ask yourself if the co-agents you appoint can discuss and decide with each other so there is no standstill for the hospital staff, because timing and the need for a decision can be important in your treatment.

Best Practices for Choosing Healthcare Agents

Select a Single Agent: To minimize potential conflicts, appoint one trusted individual as your healthcare agent.​ Choose someone you trust will carry out your wishes.  

Communicate Your Wishes Clearly: Discuss your medical preferences in detail with your agent. This ensures they understand and are willing to honor your decisions.

Document Preferences Thoroughly: Clearly outline your medical treatment preferences in your advance directive to guide your agent and healthcare providers.​

Review and Update Documents Regularly: Periodically reassess your advance directive and medical power of attorney. Your preferences may change over the years. Updating your documents regularly ensures your documents reflect your current wishes and that your chosen agent remains willing and able to act on your behalf.

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