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Signing a healthcare power of attorney and an advance directive is the easy part. It takes an afternoon. What takes longer, and what most people skip, is deciding what those documents should actually say.
Renee Parris devotes a whole lesson to the decisions themselves — not the paperwork, the content. And her first move is to widen the frame, because almost everyone assumes these documents are about one moment: the ventilator, the plug, the end. They are not. Most of what they govern happens years before that.
Four Scenarios, Not One
I’m giving you the authority to do what you think is best for me based on me. You know me, you know, my religious beliefs, you know, my moral beliefs, you know, how I feel about medical facilities, whatever it is. You trust that person to be your voice when you don’t have one, to sign your name when you cannot.
For your agent to be your voice, they need to know what you would say in four different situations. Here they are.
1. You Will Recover, But Not Today
The most common use of a healthcare directive is temporary. A bad accident, a stroke, a surgery that goes sideways — you are expected to come back, but for now you cannot communicate.
If you are incapacitated what treatment do you want or don’t want? So what do you want somebody to do? How do you want them to make those decisions around those treatments?
This is where you set parameters: which interventions you are comfortable with, which you would rather avoid, and for how long. Ventilation, transfusion, surgery, feeding support — all of it is on the table during a temporary crisis, and your agent will be asked about all of it.
Worth knowing: establishing incapacity takes one physician’s signature. That is a low bar by design, because temporary incapacity needs a fast response. It also means your agent’s authority can switch on quickly, which is a reason to have given them real instructions in advance.
2. You Will Not Recover, But You Are Not Dying
This is the scenario people leave out, and it is the one most likely to happen. Dementia and Alzheimer’s do not resolve. There is no moment when you wake up and resume decision-making.
If you have something cognitively disabling like dementia or Alzheimer’s. Do you want to go live in a facility? How do you want to be treated? Where do you want that care to take place? All of those types of decisions because if you are incapacitated in another way maybe there’s gonna be recovery. But cognitively you’re not going to recover from Alzheimer’s or dementia. So at what point do you want them to assume guardianship over you over your financial assets? Those types of decisions you need to think about and make.
Two distinct questions live in there.
Where do you want to be? In-home care with help coming to you, assisted living, a dedicated memory care facility. There are real cost and quality differences, and your preference is worth recording while you can still state it.
When should someone else take over your money? Cognitive decline is gradual. There is a long stretch where you are still signing things and no longer evaluating them well. If your documents name a trigger — a diagnosis, a physician’s determination, a specific level of impairment — your agent can step in on your terms.
If your documents are silent, the alternative is guardianship, which means a courtroom, a judge, filings in the public record, and legal fees, often while family members disagree about whether it is time. Setting the trigger yourself avoids all of it.
3. True End of Life
Here, the standard tightens considerably. Renee’s description of the process is the detail that puts most people at ease.
At very end of life when you are terminally ill which by the way when you’re incapacitated it takes one doctor to say that one doctor to sign saying you’re incapacitated. End of life it requires two doctors. Two doctors and a series of tests that the hospitals will do to say there’s no brain activity. Organs really are shutting down like this is we’re really at end of life here. We got a whole group of people and a whole science-based methodologies to prove we’re end of life. What do you want done in that case?
The specific protocol varies by state and by facility, but the principle holds: an end-of-life directive is not something a single stressed physician or an anxious relative can trigger. It takes independent medical confirmation and objective testing.
What that means practically is that you can be direct in this section without fear. The question in front of you is narrow: under confirmed, tested, irreversible conditions, do you want life support continued, or do you want comfort-focused palliative care and a natural passing? Answer it plainly. The safeguards are there to make sure the question is only ever asked when it genuinely applies.
4. A Mental Health Crisis
Renee includes a category most estate planning conversations never touch.
Now we’re also adding in mental illness, right? If you are mentally ill, do you want your power of attorney to have control over… the decisions that need to get made about? Do you have therapy? Do you go live in a facility? Are you in rehab? What pharmaceuticals you can take? Like people can manage your mental health issues as well. So all of those are decisions that you just need to start thinking about.
Some states offer a dedicated psychiatric advance directive; elsewhere the provisions go into your healthcare proxy. Either way, the decisions available to you include which treatments you consent to in advance, which medications you have reacted badly to and want avoided, whether inpatient care is acceptable and under what conditions, and who should be contacted.
Documenting this does two things. It speeds up treatment during a crisis, when delay is the main enemy. And it means the treatment reflects what you decided while well, rather than what was available in the moment.
Write It Down and Say It Out Loud
Renee is emphatic that the document alone is not enough. Your agent needs the conversation too.
And to make sure they know they hear me verbally while I can verbally say this is what I want. I’m putting it all in writing too, but I’m helping them know I’m giving you this trusted position.
The written document gives your agent legal authority. The conversation gives them the confidence to use it. An agent who has heard you say it, in your own words, with your reasoning, will not second-guess themselves in a hallway at 2 a.m. — and will not be talked out of it by a relative with a different opinion.
Your Homework
- Write down your treatment preferences for a temporary, recoverable incapacity, including how long you would want aggressive intervention attempted.
- State where you want to live if you develop dementia, and name the trigger that hands financial control to your agent.
- Decide your end-of-life preference, knowing it only applies after independent medical confirmation.
- If mental health is part of your history or your family’s, document your treatment and medication preferences.
- Have the conversation with your agent. Then have it again in a few years.
None of this is pleasant to sit with. But each answer you write down is a decision your family will not have to make for you, under pressure, hoping they got it right.
This article is for educational purposes only and does not constitute legal, medical, or psychiatric advice. Standards for determining incapacity, guardianship procedures, end-of-life protocols, and the availability of psychiatric advance directives vary by state and by facility. Consult a licensed estate planning attorney and your healthcare providers in your state before executing any healthcare directive or naming an agent.
About the instructor: Renee Parris is an estate planning educator with over 30 years of experience. This article is a companion piece to Renee’s course, Estate Planning, Simplified.
