Pennsylvania's Advance Directive for Health Care (20 Pa.C.S. Chapter 54) combines your living will and healthcare power of attorney into one document. But most people sign one without understanding what it actually does — or more importantly, what happens if they don't have one.
A properly drafted advance directive has two components, and they serve different functions:
You need both components. A living will without an agent leaves no one authorized to make the decisions your living will doesn't address. An agent without a living will has authority but no guidance about your wishes.
When a patient cannot make medical decisions and has no advance directive, Pennsylvania law (20 Pa.C.S. § 5461) establishes a default hierarchy of surrogates who may consent to treatment on the patient's behalf:
This sounds orderly on paper. In practice, it creates three problems:
⚠ The Hospital Bed Is Too Late
We get calls from families in hospital waiting rooms asking whether they can get a healthcare directive signed now. Sometimes they can — if the patient still has capacity to understand and sign. But often they can't, because the crisis that brought the patient to the hospital is the same crisis that took away their capacity. The time to execute a healthcare directive is when you are healthy and the conversation is calm. Not when you're sedated in the ICU.
A POLST form is not the same thing as an advance directive. A POLST is a medical order — a bright pink form signed by a physician (or CRNP/PA) that translates a patient's treatment preferences into specific orders that first responders and hospital staff follow immediately. An advance directive requires interpretation; a POLST is an order.
Key differences:
POLST forms are typically appropriate for patients with serious illness who have made clear treatment decisions. They are not a substitute for an advance directive — they work alongside one.
Pennsylvania's Advance Directive for Health Care (Chapter 54) includes provisions for mental health treatment. You can specify preferences for psychiatric hospitalization, medication, electroconvulsive therapy, and other treatments in the event of a mental health crisis that renders you unable to make decisions. This is particularly important for individuals with conditions like bipolar disorder, schizophrenia, or severe depression where past episodes inform what treatments are acceptable.
Your healthcare directive should be accompanied by a HIPAA authorization allowing your agent to access your medical records. Without this, healthcare providers may refuse to share information with your agent — even though the agent has authority to make decisions. This is not theoretical; it happens regularly. The HIPAA authorization should be a separate document (not buried inside the directive) so it can be presented independently to records departments, insurance companies, and pharmacies.
Practical Tips
(1) Give copies to your healthcare agent, your primary care physician, your hospital of preference, and your family. Keep the original in a known, accessible location — not a safe deposit box. (2) Pennsylvania does not have a healthcare directive registry, so the document is only useful if people know it exists and can find it. (3) Review and re-sign every 5–7 years or after any major health event. An advance directive from 20 years ago may not reflect your current wishes — and an undated, yellowed document raises questions about your current intent.
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