When clients review a Health Care Power of Attorney (HCPOA), one of the first reactions is:
“Why are there so many choices?”
It can feel overwhelming — but those options exist for a reason.
A Health Care Power of Attorney is designed to give someone you trust the authority to make medical decisions if you cannot. Because medical situations vary widely, the document includes multiple decision points to reflect your personal wishes, beliefs, and values.
Let’s break down what those options typically mean.
1. Naming Your Health Care Agent (and Alternates)
The most important decision is who will make decisions for you.
Most HCPOAs allow you to:
- Name a primary agent
- Name one or more backup agents
- Decide whether co-agents can act together or independently
Why this matters:
If your first choice is unavailable, incapacitated, or unwilling to serve, having alternates prevents delays or court involvement.
2. When Does the HCPOA Take Effect?
Some states allow you to choose:
- Effective immediately, or
- Only upon incapacity (when a doctor certifies you cannot make decisions)
Most health care POAs function upon incapacity, but the document may clarify how that incapacity is determined.
3. Scope of Authority
Many HCPOAs ask whether you want your agent to have authority over:
- Medical treatment decisions
- Surgical procedures
- Medication approval
- Hospital and facility admissions
- Psychiatric treatment
- Access to medical records (HIPAA authorization)
- Placement in long-term care facilities
These options define how broad your agent’s authority will be.
4. Life-Sustaining Treatment Decisions
This is often the most sensitive section.
You may be asked about:
- Mechanical ventilation
- Feeding tubes (artificial nutrition and hydration)
- CPR
- Dialysis
- Resuscitation orders
- End-of-life care
You might choose:
- To receive all life-prolonging treatment
- To withhold treatment in terminal conditions
- To allow comfort care only
These provisions often overlap with what is sometimes called a “Living Will.”
5. Organ and Tissue Donation
Many HCPOAs include options regarding:
- Organ donation for transplant
- Donation for research
- Donation for education
You can accept, decline, or leave that decision to your agent.
6. Pain Relief and Palliative Care
You may be asked whether you want:
- Maximum pain relief, even if it may hasten death
- Comfort-focused care
- Hospice care
This section ensures your wishes regarding quality of life are honored.
7. Mental Health Treatment Authority
Some documents include separate authorization for:
- Psychiatric medications
- Inpatient mental health treatment
- Electroconvulsive therapy (ECT)
Because mental health laws can be more restrictive, specific consent language is often included.
8. Pregnancy Provisions
Some forms address how directives apply if you are pregnant.
State law may limit certain decisions during pregnancy, so this language can be required.
9. Anatomical Gifts and Burial Instructions
Some HCPOAs include optional sections regarding:
- Final disposition preferences
- Cremation vs. burial
- Funeral arrangements
These are sometimes handled in separate documents.
Why So Detailed?
Medical situations are complex and unpredictable.
The detailed options allow you to:
- Express your values clearly
- Reduce family conflict
- Prevent uncertainty
- Guide your agent in difficult situations
Without clear instructions, loved ones may struggle to guess what you would have wanted.
Do You Have to Fill Out Every Option?
Not necessarily.
You can:
- Leave certain decisions fully to your agent
- Provide general guidance instead of detailed instructions
- Customize the document based on your preferences
The goal is clarity — not perfection.
The Bottom Line
A Health Care Power of Attorney contains many options because it covers some of the most serious decisions that can arise in life.
Taking the time to understand those choices gives:
- You peace of mind
- Your loved ones guidance
- Your agent clear authority
- Medical providers clear direction
If you are reviewing an HCPOA and feeling overwhelmed, that’s normal. The key is making sure the document reflects your values and that the person you choose understands your wishes.
HCPOA FAQs
1. What is a Health Care Power of Attorney?
A Health Care Power of Attorney (HCPOA) is a legal document that allows you to appoint someone (your “agent”) to make medical decisions for you if you cannot make them yourself.
2. When does a Health Care Power of Attorney take effect?
In most cases, it becomes effective when a physician determines that you are unable to make your own medical decisions.
3. Is a Health Care Power of Attorney the same as a Living Will?
Not exactly.
- A Living Will states your wishes about life-sustaining treatment.
- A Health Care Power of Attorney appoints someone to make decisions for you.
Many modern documents combine both into one.
4. Who should I choose as my health care agent?
Choose someone who:
- Is calm under pressure
- Can make difficult decisions
- Will follow your wishes (even if others disagree)
- Is geographically available if possible
This is often a spouse, adult child, sibling, or close friend.
5. Can I name more than one agent?
Yes.
You can:
- Name co-agents (to act together or independently), or
- Name a primary agent and one or more alternates
Most attorneys recommend naming alternates to avoid delays.
6. What decisions can my agent make?
Depending on how the document is drafted, your agent may make decisions regarding:
- Surgeries and medical treatments
- Life-sustaining measures
- Feeding tubes and ventilators
- Nursing home placement
- Access to medical records
- Organ donation
7. Can I limit my agent’s authority?
Yes. You can provide specific instructions or restrictions within the document.
8. Can I change or revoke my HCPOA?
Yes — as long as you are mentally competent, you can revoke or update your Health Care Power of Attorney at any time.
9. What happens if I don’t have one?
If you become incapacitated without an HCPOA:
- Family members may disagree about decisions.
- Doctors may face uncertainty.
- A court guardianship proceeding may be required.
That process can be costly and time-consuming.
10. Do I need to give copies to anyone?
Yes. You should provide copies to:
- Your health care agent
- Backup agents
- Your primary physician
- Trusted family members
HCPOA Checklist
Before signing your HCPOA, consider the following:
Choosing Your Agent
☐ Have I selected someone I fully trust?
☐ Have I discussed my wishes with them?
☐ Have I named at least one alternate?
☐ Does my agent understand my values and beliefs?
Medical Treatment Preferences
☐ Do I want all life-sustaining treatment if I am terminally ill?
☐ Do I want artificial nutrition or hydration in certain situations?
☐ Do I prefer comfort-focused care only?
☐ Have I discussed my wishes about CPR or resuscitation?
End-of-Life Planning
☐ Have I considered hospice care preferences?
☐ Do I want maximum pain relief even if it may shorten life?
☐ Have I expressed spiritual or religious preferences?
Organ Donation
☐ Do I wish to donate organs?
☐ For transplant only?
☐ For research or education?
☐ Should my agent decide?
Mental Health Treatment
☐ Do I authorize psychiatric treatment if necessary?
☐ Are there specific treatments I want to limit?
Communication
☐ Have I given copies to my agent and alternates?
☐ Have I informed close family members of my decision?
☐ Do I know where the original document is stored?
Final Thoughts
A Health Care Power of Attorney is one of the most important documents in your estate plan. It protects you during medical emergencies and gives your loved ones clear direction during difficult times.
Taking a few minutes to thoughtfully complete this document can prevent confusion, conflict, and court involvement later.
Understanding HCPOA Treatment Choices in Pennsylvania
When completing a Health Care Power of Attorney in Pennsylvania, you may be asked to initial your preferences regarding certain life-sustaining treatments.
These choices typically apply if you are:
- In a terminal condition, or
- In a permanent state of unconsciousness, and
- There is no realistic hope of significant recovery
Here’s what each option means in practical terms.
Life-Sustaining Treatment Options Explained
Heart–Lung Resuscitation (CPR)
What it is:
CPR is an emergency procedure used when your heart stops beating or you stop breathing. It may involve chest compressions, electric shocks (defibrillation), or emergency medications.
If you choose YES:
Medical staff will attempt to restart your heart.
If you choose NO:
You are choosing a “Do Not Resuscitate” (DNR) preference in certain qualifying circumstances.
Important: CPR in seriously ill or frail patients is often physically traumatic and may have low success rates depending on the medical condition.
Mechanical Ventilator (Breathing Machine)
What it is:
A machine that helps you breathe if you cannot breathe on your own. A tube is typically inserted into your throat.
If you choose YES:
You are consenting to being placed on life support.
If you choose NO:
You do not want artificial breathing support if you cannot breathe independently under qualifying conditions.
Dialysis (Kidney Machine)
What it is:
A machine that filters waste from your blood if your kidneys fail.
If you choose YES:
You are agreeing to dialysis treatment.
If you choose NO:
You are declining artificial kidney support in terminal or permanent unconscious conditions.
Surgery
What it is:
Operations that may attempt to correct or treat medical conditions.
If you choose YES:
You are allowing surgical interventions even in serious circumstances.
If you choose NO:
You are declining invasive surgical treatment if you are terminally ill or permanently unconscious.
Chemotherapy
What it is:
Drug treatment commonly used to fight cancer.
If you choose YES:
You are consenting to cancer treatment even if you are seriously ill.
If you choose NO:
You are declining aggressive cancer treatment in qualifying end-stage situations.
Radiation Treatment
What it is:
Cancer treatment using high-energy radiation to shrink tumors.
Your choice here reflects whether you would want radiation therapy in terminal or permanent unconsciousness scenarios.
Antibiotics
What it is:
Medication used to treat infections.
Some people choose to receive antibiotics even if they decline other aggressive treatments because they may improve comfort.
Others decline antibiotics if the underlying condition is terminal.
Artificial Nutrition and Hydration (Tube Feedings)
This section addresses whether you want food or water delivered artificially through:
- A tube in the nose or stomach
- A feeding tube surgically inserted
- Intravenous (IV) hydration
This applies if you are:
- Terminally ill, or
- Permanently unconscious, and
- There is no realistic hope of recovery.
You must initial only one:
TUBE FEEDINGS
You want artificial nutrition and hydration provided.
NO TUBE FEEDINGS
You do not want artificial feeding or hydration in those circumstances.
This is often one of the most emotionally difficult decisions. Some view artificial feeding as basic care; others view it as medical life-prolonging intervention.
Agent’s Use of Instructions
You must initial only one option:
“My agent must follow these instructions.”
This means:
- Your written choices are binding.
- Your agent cannot override them.
- Your wishes control.
OR
“These instructions are only guidance.”
This means:
- Your agent has flexibility.
- Your agent may override your instructions if circumstances warrant.
- Your agent can adapt to medical realities.
This option is often chosen by people who deeply trust their agent and want flexibility.
Legal Protection (Pennsylvania Law)
Pennsylvania law protects:
- Your agent
- Doctors
- Health care providers
From liability if they act in good faith in following:
- Your written instructions, or
- Your agent’s direction
This clause also states that you agree not to hold them legally responsible for acting in good faith.
It provides important reassurance to medical providers.
Organ Donation
You must initial one:
I consent to donate my organs and tissues.
You may:
- Limit donation to certain organs.
- Limit donation to transplant only.
- Exclude research or education.
OR
I do not consent to organ donation.
This means no organs or tissues will be donated at death.
What These Choices Really Mean
These decisions are not about giving up. They are about:
- Control
- Dignity
- Reducing family conflict
- Making your wishes clear
There is no “right” answer — only what aligns with your values, beliefs, and medical preferences.
Practical Advice
Before completing this section:
- Talk with your chosen health care agent.
- Discuss your values about quality of life.
- Consider religious or spiritual beliefs.
- Ask your physician questions if needed.
Clarity now prevents confusion later.
1. Simplified “Plain English” Version for Clients
What Are These Medical Choices Really Asking?
When you initial these sections, you are answering one basic question:
If I am dying or permanently unconscious, do I want doctors to use machines and aggressive treatments to keep me alive?
Here’s what each option really means in everyday language:
- CPR – If my heart stops, do I want doctors to try to restart it?
- Breathing Machine (Ventilator) – If I can’t breathe, do I want a machine to breathe for me?
- Dialysis – If my kidneys fail, do I want a machine to clean my blood?
- Surgery – Do I want operations even if I am terminally ill?
- Chemotherapy/Radiation – Do I want cancer treatment if my condition is terminal?
- Antibiotics – Do I want infections treated, even if I’m near the end of life?
- Tube Feeding – If I can’t eat or drink, do I want food and water given through a tube?
You are not deciding what happens today.
You are deciding what happens if there is no real hope of recovery.
There is no right or wrong choice — only what feels right to you.
“Must Follow” vs. “Guidance Only”
You must also decide:
- Should your agent follow your instructions exactly?
- Or should your agent have flexibility to adjust if the situation changes?
If you trust your agent completely, many people choose flexibility.
If you feel strongly about certain treatments, you may want your instructions to be binding.
2. Faith-Sensitive Version
For many people, these decisions are deeply connected to faith and spiritual beliefs.
Some important questions to consider:
- Do I believe life must be preserved at all costs?
- Do I believe there is a difference between natural death and artificially prolonging life?
- How does my faith view suffering and end-of-life care?
- Do I believe withdrawing machines is morally different from never starting them?
Many religious traditions recognize a distinction between:
- Ordinary care (comfort, warmth, pain relief), and
- Extraordinary or burdensome medical treatment (machines, invasive procedures, aggressive interventions).
You may choose:
- All life-prolonging measures
- Comfort-focused care only
- Or something in between
If your faith plays an important role in your decisions, it is wise to:
- Speak with a clergy member
- Discuss your beliefs with your health care agent
- Include faith-based language in your instructions if appropriate
Your document should reflect both your medical wishes and your spiritual values.
3. How to Talk to Your Family About These Choices
Many people avoid this conversation because it feels uncomfortable.
But avoiding it can leave your loved ones confused and burdened later.
Here is a simple way to start:
Step 1: Pick the Right Time
Choose a calm moment — not during a crisis.
You might say:
“I’m updating my estate planning documents and I want to make sure you understand my wishes.”
Step 2: Focus on Values, Not Just Treatments
Instead of listing medical procedures, talk about what matters most:
- “Quality of life is more important to me than length of life.”
- “If I can’t recognize you or communicate, I wouldn’t want aggressive treatment.”
- “I want every reasonable chance at recovery.”
- “I don’t want to suffer unnecessarily.”
Values guide decisions more than checkboxes.
Step 3: Reassure Your Loved Ones
Tell your agent:
“If you ever have to make these decisions, I want you to know you are honoring my wishes.”
That removes guilt and second-guessing later.
Step 4: Put It in Writing
Once you’ve had the conversation:
- Make sure your Health Care Power of Attorney reflects your wishes.
- Give copies to your agent.
- Let key family members know where it is.
Final Thoughts
These decisions are not about giving up.
They are about:
- Protecting your dignity
- Reducing family conflict
- Making your values clear
- Giving your loved ones peace of mind
The most important step is not just signing the document — it’s having the conversation.
