ALASKA ADVANCE HEALTH CARE DIRECTIVE
(Living Will & Durable Power of Attorney for Health Care)
[// GUIDANCE: This template is drafted to comply with the Alaska Uniform Health-Care Decisions Act, Alaska Stat. § 13.52.010 et seq. (2024) (“UHCDA”). Customize bracketed items, review all optional provisions, and confirm consistency with the client’s specific wishes before execution.]
TABLE OF CONTENTS
- DOCUMENT HEADER
- DEFINITIONS
- OPERATIVE PROVISIONS
3.1 Appointment of Health-Care Agent
3.2 Health-Care Instructions (Living Will)
3.3 HIPAA Authorization
3.4 Anatomical Gifts (Optional)
3.5 Mental Health Treatment Instructions (Optional) - REPRESENTATIONS & WARRANTIES
- COVENANTS & RESTRICTIONS
- DEFAULT & REMEDIES
- RISK ALLOCATION
- DISPUTE RESOLUTION
- GENERAL PROVISIONS
- EXECUTION BLOCK
A. Principal Signature
B. Witness Attestation (Alaska-Compliant)
C. Notary Acknowledgment (Optional but recommended)
1. DOCUMENT HEADER
1.1 Title. This Advance Health Care Directive (the “Directive”) is executed by [FULL LEGAL NAME OF PRINCIPAL], residing at [ADDRESS] (the “Principal”), pursuant to the Alaska UHCDA.
1.2 Effective Date. This Directive becomes effective immediately upon the Principal’s incapacitation as defined in Section 2.7, or earlier to the limited extent necessary to permit the Health-Care Agent to access protected health information under Section 3.3.
1.3 Governing Law. This Directive shall be governed by and construed in accordance with the laws of the State of Alaska, without regard to conflict-of-laws principles.
2. DEFINITIONS
For purposes of this Directive, capitalized terms have the meanings set forth below. Any term not defined shall be construed consistently with Alaska Stat. § 13.52.010 et seq.
“Agent” or “Health-Care Agent” means the individual appointed in Section 3.1.1.
“Alternate Agent” has the meaning in Section 3.1.2.
“Artificial Nutrition and Hydration” means medically supplied food or fluids delivered through tubes or intravenous means.
“Capacity” means an individual’s ability to understand the significant benefits, risks, and alternatives to proposed health care and to make and communicate a health-care decision.
“Directive” has the meaning in Section 1.1.
“Health Care” includes treatment, service, or procedure to maintain, diagnose, or otherwise affect a person’s physical or mental condition.
“Incapacity” or “Incapacitated” means lacking Capacity, as determined under Section 3.1.5.
“Life-Sustaining Treatment” means any medical intervention that uses mechanical or other artificial means to sustain, restore, or supplant a vital function and that, when withdrawn, is expected to result in death.
“Primary Physician” means the physician selected under Section 3.1.6 or, if none is selected, the attending physician.
3. OPERATIVE PROVISIONS
3.1 Appointment of Health-Care Agent
3.1.1 Primary Agent. The Principal hereby appoints [NAME OF AGENT], whose address is [ADDRESS] and telephone [PHONE], as Health-Care Agent (“Primary Agent”) with full authority to make all health-care decisions on the Principal’s behalf in accordance with this Directive and applicable law.
3.1.2 Alternate Agents. If the Primary Agent is unwilling, unable, or reasonably unavailable to act, authority passes in the following succession:
(a) [1st ALTERNATE AGENT NAME & CONTACT];
(b) [2nd ALTERNATE AGENT NAME & CONTACT].
3.1.3 Scope of Authority. Subject to Section 3.2 (Health-Care Instructions) and any limitations stated herein, the Agent has the broadest authority permitted under Alaska law, including the authority to:
(a) consent to, refuse, or withdraw any health care, including Life-Sustaining Treatment;
(b) employ and discharge health-care providers;
(c) authorize admission to or discharge from health-care facilities;
(d) access all medical records and information; and
(e) take any lawful action necessary to carry out the Principal’s wishes.
3.1.4 Limitations on Agent’s Authority. The Agent may NOT:
(a) authorize involuntary commitment or treatment where prohibited by law;
(b) consent to psychosurgery, abortion, or sterilization, unless expressly authorized below;
(c) override the Principal’s expressed wishes in Section 3.2.
3.1.5 Determination of Incapacity. Incapacity shall be determined by the Primary Physician or, if unavailable, by another licensed physician or advanced nurse practitioner, documented in writing and communicated to the Agent.
3.1.6 Selection/Change of Primary Physician. The Agent may select or change the Primary Physician consistent with Section 3.1.3(b).
[// GUIDANCE: If the Principal wants different authority levels, insert additional limitations here.]
3.2 Health-Care Instructions (Living Will)
3.2.1 End-of-Life Decisions. IF I have a terminal condition and am unable to make decisions, it is my directive that:
☐ (a) [WITHHOLD] Life-Sustaining Treatment.
☐ (b) [ADMINISTER] Life-Sustaining Treatment.
3.2.2 Artificial Nutrition and Hydration.
☐ (a) I DO NOT want Artificial Nutrition and Hydration if it will not reverse my underlying condition.
☐ (b) I DO want Artificial Nutrition and Hydration even if it only prolongs the dying process.
3.2.3 Pain Relief. I direct that adequate pain medication be administered to relieve suffering, even if it may hasten death incidentally.
3.2.4 Pregnancy. IF I am pregnant at the time decisions must be made:
☐ (a) I direct that my instructions be carried out regardless of pregnancy.
☐ (b) I direct that life-sustaining measures be continued until the fetus is viable.
3.2.5 Additional Instructions. [INSERT ANY ADDITIONAL OR CULTURALLY SPECIFIC INSTRUCTIONS].
3.3 HIPAA Authorization
Pursuant to 45 C.F.R. § 164.508, the Principal authorizes any covered entity to disclose protected health information to the Agent to the extent necessary to carry out authority under this Directive. This authorization is effective immediately and survives the Principal’s death to the extent needed to effectuate post-mortem decisions (e.g., anatomical gifts).
3.4 Anatomical Gifts (Optional)
[Complete only if the Principal wishes to make an anatomical gift.]
3.5 Mental Health Treatment Instructions (Optional)
[Insert preferences regarding psychotropic medications, electroconvulsive therapy, seclusion, or restraint.]
4. REPRESENTATIONS & WARRANTIES
4.1 Capacity. The Principal represents that, as of the execution date, the Principal:
(a) is at least 18 years of age (or an emancipated minor);
(b) is of sound mind and not acting under duress, undue influence, or fraud; and
(c) understands the nature and consequences of executing this Directive.
4.2 No Conflicting Directives. The Principal warrants that no prior directive remains in effect, or, if one exists, it is revoked pursuant to Section 9.1.
5. COVENANTS & RESTRICTIONS
5.1 Duty of Agent. The Agent covenants to act:
(a) in good faith;
(b) consistently with the Principal’s known wishes and, if unknown, in the Principal’s best interests;
(c) in accordance with Alaska Stat. § 13.52.030.
5.2 Provider Compliance. Health-care providers receiving this Directive shall comply absent knowledge of revocation, consistent with Alaska Stat. § 13.52.060.
6. DEFAULT & REMEDIES
6.1 Invalid or Unavailable Agent. If no appointed Agent is available, the default surrogacy provisions of Alaska Stat. § 13.52.080 apply.
6.2 Enforcement. Any interested person may petition a court of competent jurisdiction in Alaska for injunctive or declaratory relief to enforce this Directive.
6.3 Attorneys’ Fees. The prevailing party in any action to enforce this Directive is entitled to reasonable attorneys’ fees and costs.
7. RISK ALLOCATION
7.1 Indemnification of Providers. A health-care provider or facility acting in good faith and in reliance on this Directive is indemnified and held harmless by the Principal’s estate from any civil liability, consistent with Alaska Stat. § 13.52.060(b).
7.2 Limitation of Liability. No provider shall be liable for claims arising from good-faith compliance with this Directive, except for gross negligence or willful misconduct.
8. DISPUTE RESOLUTION
8.1 Governing Law. See Section 1.3.
8.2 Injunctive Relief. Because monetary damages are inadequate to remedy violations of personal health-care autonomy, injunctive relief is an appropriate and necessary remedy to enforce this Directive.
[// GUIDANCE: Arbitration and jury-waiver provisions are intentionally omitted per user metadata.]
9. GENERAL PROVISIONS
9.1 Revocation & Amendment. The Principal may revoke or amend this Directive at any time by:
(a) a signed, dated writing;
(b) oral expression of intent in the presence of a witness 18 years or older;
(c) physically destroying or directing another to destroy the document; or
(d) executing a subsequently dated directive.
9.2 Copies. Photocopies or electronically transmitted copies of this Directive have the same force as the original.
9.3 Severability. Should any provision be held invalid, the remaining provisions remain enforceable.
9.4 Integration. This Directive constitutes the entire directive of the Principal concerning health-care decisions and supersedes all prior inconsistent directives.
9.5 Counterparts & Electronic Signatures. This Directive may be executed in counterparts and by electronic signature to the fullest extent permitted by law.
10. EXECUTION BLOCK
A. Principal Signature
I have read and understand this Directive and execute it voluntarily.
| ____ | ___ |
| [PRINCIPAL NAME] | Date |
B. Witness Attestation (Alaska-Compliant)
We declare under penalty of perjury that:
1. The Principal is personally known to us, appeared to be of sound mind, and signed or acknowledged this Directive willingly;
2. The Principal did not sign under duress, fraud, or undue influence;
3. We are at least 18 years of age, not appointed in this Directive, not the Principal’s health-care provider or employee thereof, not related to the Principal by blood, marriage, or adoption, and not entitled to any portion of the Principal’s estate.
| Witness #1 Signature ___ | Date _ |
| Print Name & Address: ________ |
| Witness #2 Signature ___ | Date _ |
| Print Name & Address: ________ |
C. Notary Acknowledgment (Optional but Recommended)
State of Alaska )
) ss.
Judicial District ___)
On this _ day of _, 20, before me, [NOTARY NAME], a Notary Public in and for said State, personally appeared [PRINCIPAL NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to this instrument and acknowledged that he/she executed the same for the purposes herein contained.
| ____ |
| Notary Public for Alaska |
My Commission Expires: __
[// GUIDANCE: 1) Provide executed copies to the Agent, Alternate Agents, Primary Physician, and any relevant health-care facility. 2) Consider filing a copy with the Alaska Health Care Decisions Registry if available. 3) Review annually and upon major life events.]