New Hampshire Statutory Durable Power Of Attorney For Health Care
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NEW HAMPSHIRE STATUTORY DURABLE
POWER OF ATTORNEY FOR HEALTH CARE
INFORMATION CONCERNING THE DURABLE POWER OF ATTORNEY
FOR HEALTH CARE
THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS
DOCUMENT YOU SHOULD KNOW THESE IMPORTANT FACTS:
Except to the extent you state otherwise, this document gives the person you name as your agent the
authority to make any and all health care decisions for you when you are no longer capable of making them yourself.
“Health care” means any treatment, service or procedure to maintain, diagnose or treat your physical or mental
condition. Your agent, therefore, can have the power to make a broad range of health care decisions for you.
Your agent may consent, refuse to consent or withdraw consent to medical treatment and may make decisions about
withdrawing or withholding life-sustaining treatment. Your agent cannot consent or direct any of the following:
commitment to a state institution, sterilization or termination of treatment if you are pregnant and if the withdrawal
of that treatment is deemed likely to terminate the pregnancy unless the failure to withhold the treatment will be
physically harmful to you or prolong severe pain which cannot be alleviated by medication.
You may state in this document any treatment you do not desire, except as stated above or treatment you
want to be sure you receive. Your agent’s authority will begin when your doctor certifies that you lack the capacity
to make health decisions. If for moral or religious reasons you do not wish to be treated or examined by a doctor or
examined by a doctor for the certification that you lack capacity, you must say so in the document and name a
person to be able to certify your lack of capacity. That person may not be your agent or alternate agent or any person
ineligible to be your agent. You may attach additional pages if you need more space to complete your statement.
If you want to give your agent authority to withhold or withdraw the artificial providing of nutrition and
fluids, your document must say so otherwise your agent will not be able to direct that. Under no conditions will your
agent be able to direct the withholding of food and drink for you to eat and drink normally.
It is important that you discuss this document with your physician or other health care providers before you
sign it to make sure that you do understand the nature and range of decisions which may be made on your behalf. If
you do not have a physician, you should talk to someone else who is knowledgeable about these issues and can
answer your questions. You do not need a lawyer’s assistance to complete this document, but if there is anything in
this document that you do not understand, you should ask a lawyer to explain it to you.
The person that you appoint as agent should be someone you know and trust and must be at least 18 years
of age. If you appoint your health or residential care provider (e.g. your physician, or an employee of a home health
agency, hospital, nursing home or residential care home other than a relative), that person will have to choose
between acting as your agent or as your health or residential care provider; the law does not permit a person to do
both at the same time.
You should inform the person you appoint that you want him or her to be your health care agent. You
should discuss this document with your agent and your physician and give each a signed copy. You should indicate
on the document itself the people and institutions who will have signed copies. Your agent will not be liable for
health care decisions made in good faith on your behalf.
Even after you have signed this document, you have the right to make health care decisions for yourself as
long as you are able to do so, and treatment cannot be given to you or stopped over your objection. You have the
right to revoke the authority granted to your agent by informing him or her or your health care provider orally or in
writing.
This document may not be changed or modified. If you want to make changes in the document, you must
make an entirely new one.
You should consider designating an alternate agent in the event that your agent is unwilling, unable,
unavailable or ineligible to act as your agent. Any alternate agent you designate will have the same authority to
make health care decisions for you.
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