Durable Power Of Attorney For Health Care Decisions Page 2
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12ADVANCE HEALTH CARE DIRECTIVE
EXPLANATION
You have the right to give instructions about your own health care to the extent allowed
by law. You also have the right to name someone else to make health care decisions for you to
the extent allowed by law. This form lets you do either or both of these things. It also lets you
express your wishes regarding the designation of your health care provider. If you use this
form, you may complete or modify all or any part of it. You are free to use a different form if
the form complies with the requirements of AS 13.52.
Part 1 of this form is a durable power of attorney for health care. A "durable
power attorney for health care" means the designation of an agent to make health care
decisions for you. Part 1 lets you name another individual as an agent to make health care
decisions for you if you do not have the capacity to make your own decisions or if you want
someone else to make those decisions for you now even though you still have the capacity to
make those decisions. You may name an alternate agent to act for you if your first choice is not
willing, able, or reasonably available to make decisions for you. Unless related to you, your
agent may not be an owner, operator, or employee of a health care institution where you are
receiving care.
Unless the form you sign limits the authority of your agent, your agent may make all
health care decisions for you that you could legally make for yourself. This form has a place for
you to limit the authority of your agent. You do not have to limit the authority of your agent if
you wish to rely on your agent for all health care decisions that may have to be made.
If you choose not to limit the authority of your agent, your agent will have the right, to
the extent allowed by law, to
(a) consent or refuse consent to any care, treatment, service, or procedure to
maintain, diagnose, or otherwise affect a physical or mental condition, including the
administration or discontinuation of psychotropic medication;
(b) select or discharge health care providers and institutions;
(c) approve or disapprove proposed diagnostic tests, surgical procedures, and
programs of medication; and
(d) direct the provision, withholding, or withdrawal of artificial nutrition and
hydration and all other forms of health care; and
(e) make an anatomical gift following your death.
Part 2 of this form lets you give specific instructions for any aspect of your
health care to the extent allowed by law, except you may not authorize mercy killing,
assisted suicide, or euthanasia.
Choices are provided for you to express your wishes regarding the provision, withholding,
or withdrawal of treatment to keep you alive, including the provision of artificial nutrition and
hydration, as well as the provision of pain relief medication. Space is provided for you to add to
the choices you have made or for you to write out any additional wishes.
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