Advance Directive for Health Care

By Ryan W. Collier

Oregon is a pioneer in its progressive approach to health care issues. Not the least of these is the statute adopting an Advance Directive for Health Care (ADHC). ORS 127.505 et seq. The statute provides a form document that allows a client both to make decisions regarding end-of-life care and life support issues, and to create a basic power of attorney for health care issues. Under the ADHC, an appointed health care representative holds authority over all the principal’s health care that the principal would have if not incapacitated. ORS 127.535.

The ADHC requires two witnesses. The health care representative and alternate, and the attending physician cannot serve as witnesses. The health care representative and alternate have to agree to accept the appointment. The principal can revoke either the ADHC or a specific health care decision, in writing or otherwise. ORS 127.545.

The ADHC does have several limitations. The health care representative has authority to make health care decisions when the principal’s attending physician (or a court) determines that the principal lacks the ability to make and communicate health care decisions. ORS 127.505(13). The ADHC provides no authority relating to mental health treatment, convulsive treatment, psychosurgery, sterilization, and abortion. The health care representative also does not have authority over life-sustaining procedures unless specifically granted authority in Part B, Section 2 and 3 of the form. The authority also likely excludes issues related to organ donation, autopsy, and experimental treatments. Additional documents may be required for these situations. The ADHC provides a useful tool to discuss end-of-life care with clients. It encourages the client to discuss issues that are often difficult, such as death and dying.