ADVANCE HEALTH-CARE DIRECTIVE

(Living Will & Durable Power of Attorney for Health Care)

State of Delaware – 16 Del. C. ch. 25 Compliant

[// GUIDANCE: This template merges a Living Will with a Durable Power of Attorney for Health Care, as expressly permitted under Delaware’s Advance Health-Care Directive Act, 16 Del. C. §§ 2501 et seq. Customize ALL bracketed fields and delete inapplicable options before execution.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
  3.1 Appointment of Agent
  3.2 Powers of Agent
  3.3 Alternate Agent(s)
  3.4 Statement of Desires & Special Instructions
  3.5 End-of-Life Decisions
  3.6 Organ & Tissue Donation
  3.7 HIPAA Authorization
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Revocation, Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1. Title. This Advance Health-Care Directive (“Directive”) is executed by [DECLARANT FULL LEGAL NAME], of [DECLARANT ADDRESS] (“Declarant”).
2. Effective Date. This Directive is effective on the latest date of execution set forth in Section X (Execution Block) (the “Effective Date”).
3. Governing Law. This Directive shall be governed by and construed in accordance with the health-care laws of the State of Delaware.
4. Purpose & Consideration. Declarant, being of sound mind and acting voluntarily, issues this Directive to:
   a. appoint a health-care agent; and
   b. provide advance instructions concerning health-care decisions, including end-of-life care, consistent with 16 Del. C. ch. 25.

II. DEFINITIONS

“Act” means Delaware’s Advance Health-Care Directive Act, 16 Del. C. §§ 2501 et seq.
“Agent” means the individual appointed in Section 3.1 to make health-care decisions for Declarant when Declarant lacks Capacity.
“Alternate Agent” means the individual(s) named in Section 3.3 who may act if the primary Agent is unavailable, unwilling, or ineligible.
“Artificial Nutrition and Hydration” means invasive feeding or fluid administration (e.g., via tube or IV) intended to provide nutritional support when Declarant cannot eat or drink normally.
“Capacity” has the meaning set forth in 16 Del. C. § 2501(c) (i.e., an individual’s ability to understand and appreciate the nature and consequences of a health-care decision).
“Health-Care Decision” includes consent, refusal, or withdrawal of any treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition.
“Life-Sustaining Treatment” means any medical intervention that, when administered to a patient with a terminal condition or permanent unconsciousness, merely prolongs the dying process and does not provide a curative benefit.
“Permanent Unconsciousness” means a medical condition in which Declarant is irreversibly unaware of self and surroundings, including a persistent vegetative state.
“Terminal Condition” means an illness or injury with no reasonable medical expectation of recovery that will result in death regardless of the continued application of life-sustaining treatment.

III. OPERATIVE PROVISIONS

3.1 Appointment of Agent

1. Primary Agent. Declarant hereby appoints [PRIMARY AGENT FULL NAME], residing at [ADDRESS], Phone: [PHONE], as Agent.
2. Grant of Authority. Subject to the limitations stated herein, Agent may make any and all health-care decisions for Declarant that Declarant could make if Declarant had Capacity, including decisions regarding mental-health treatment.
3. Commencement. Agent’s authority shall commence upon a determination by the attending physician or advanced practice registered nurse (“APRN”) that Declarant lacks Capacity, unless Declarant checks the following box:
   [ ] AUTHORITY EFFECTIVE IMMEDIATELY.

[// GUIDANCE: If immediate authority is granted, Agent may act even while Declarant retains Capacity, which can simplify administrative matters but reduces Declarant’s exclusive control.]

3.2 Powers of Agent

1. General Powers. Agent is authorized to:
   a. consent to, refuse, or withdraw any health-care treatment or procedure;
   b. admit or discharge Declarant from any health-care facility;
   c. have access to medical records and disclose them as necessary;
   d. execute waivers of liability on Declarant’s behalf;
   e. authorize autopsy and disposition of remains, unless Declarant directs otherwise.
2. Limitations. Agent’s authority is subject to Declarant’s specific instructions in Section 3.4 and statutory limitations under the Act.

3.3 Alternate Agent(s)

If the primary Agent is unable, unwilling, or ineligible to serve, Declarant appoints the following, in the order listed, as Alternate Agent(s):
1. First Alternate: [ALT AGENT #1 NAME], Address: [ADDRESS], Phone: [PHONE]
2. Second Alternate: [ALT AGENT #2 NAME], Address: [ADDRESS], Phone: [PHONE]

3.4 Statement of Desires & Special Instructions

[// GUIDANCE: Check or complete all that apply. Where brackets appear, insert additional detail or strike out inapplicable text.]

1. Pain Relief.
   [ ] I desire maximum pain relief, even if it hastens my death.
   [ ] I desire pain relief only to the extent it does NOT materially shorten my life.

2. Artificial Nutrition & Hydration.
   [ ] I REFUSE artificial nutrition and hydration when I am in a Terminal Condition or Permanent Unconsciousness.
   [ ] I DESIRE artificial nutrition and hydration unless it causes undue burden or merely prolongs the dying process.

3. Mental-Health Treatment.
   [ ] I authorize Electro-Convulsive Therapy (ECT) if clinically indicated.
   [ ] I refuse ECT under any circumstance.

4. Pregnancy Exception. (Delaware law may restrict withdrawal of life-sustaining treatment during pregnancy.)
   [ ] I understand and accept current statutory restrictions.
   [ ] I direct my Agent to seek judicial relief to enforce my instructions notwithstanding pregnancy, where legally permissible.

5. Additional Instructions or Limitations on Agent’s Authority:
   [________]

3.5 End-of-Life Decisions

If I (Declarant) am determined by two qualified physicians or an attending physician/APRN and a second physician/APRN to be in a Terminal Condition or Permanent Unconsciousness, my wishes are:
1. Life-Sustaining Treatment.
[ ] WITHHOLD or WITHDRAW all Life-Sustaining Treatment.
[ ] CONTINUE Life-Sustaining Treatment as long as medically reasonable.

2. Resuscitation (CPR).
   [ ] DO NOT attempt resuscitation (DNR).
   [ ] Attempt resuscitation unless clinically futile.

3. Dialysis & Mechanical Ventilation.
   [ ] Refuse. [ ] Accept. [ ] Accept trial period of [__] days.

3.6 Organ & Tissue Donation

1. Preference.
   [ ] I do NOT wish to make an anatomical gift.
   [ ] I hereby make an anatomical gift to be effective upon my death.
2. Extent of Gift. (check one)
   [ ] Any needed organs/tissues.
   [ ] Only the following: [________]
3. Purpose of Gift. (check one)
   [ ] Transplantation [ ] Therapy [ ] Research [ ] Education

3.7 HIPAA Authorization

I authorize any health-care provider to disclose my protected health information to my Agent (and Alternate Agent(s)), consistent with the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. § 1320d et seq., and applicable Delaware law, for any purpose related to this Directive.

IV. REPRESENTATIONS & WARRANTIES

1. Declarant represents that:
   a. Declarant is at least 18 years of age and presently has Capacity;
   b. Execution of this Directive is voluntary and free of undue influence; and
   c. All prior advance directives are hereby revoked to the extent inconsistent herewith.
2. Agent and Alternate Agent(s) (by later acceptance) represent that they:
   a. Are at least 18 years old and not employed by Declarant’s primary health-care provider;
   b. Have read this Directive and agree to act in good faith and in accordance with Declarant’s wishes.

V. COVENANTS & RESTRICTIONS

1. Agent shall:
   a. Act in accordance with Declarant’s expressed wishes and best interests;
   b. Consult available medical personnel and family members as appropriate;
   c. Keep accurate records of significant health-care decisions.
2. Agent shall not:
   a. Authorize sterilization or abortion except as expressly directed;
   b. Commit Declarant to a mental institution for more than 14 days without court order, unless permitted by law;
   c. Receive any financial compensation other than reimbursement for reasonable expenses.

VI. REVOCATION, DEFAULT & REMEDIES

1. Revocation by Declarant. Declarant may revoke this Directive at any time by:
   a. A signed, dated writing;
   b. Physical cancellation or destruction of this document;
   c. An oral statement of intent to revoke, communicated to a health-care provider; or
   d. Execution of a subsequent advance directive.
2. Effect of Divorce. If Declarant’s spouse is named as Agent and the marriage is subsequently dissolved, the designation of that spouse as Agent is revoked unless Declarant affirmatively re-appoints the former spouse in writing.
3. Remedies. Any individual acting in contravention of this Directive may be subject to injunctive relief under Delaware law.

VII. RISK ALLOCATION

1. Good-Faith Immunity. No health-care provider or Agent acting in good faith reliance on this Directive shall incur civil or criminal liability or be subject to professional discipline for such reliance, consistent with 16 Del. C. § 2509.
2. Indemnification. Declarant’s estate shall indemnify and hold harmless any person who acts in good faith under this Directive from any liability, expense, or loss arising therefrom, except to the extent of such person’s gross negligence or willful misconduct.
3. Liability Cap. Any monetary liability of an indemnified party under this Directive shall not exceed amounts recoverable under applicable professional liability insurance, absent gross negligence or bad faith.

VIII. DISPUTE RESOLUTION

1. Governing Law. All questions arising under this Directive shall be determined in accordance with the substantive laws of the State of Delaware.
2. Forum Selection. Any judicial proceeding shall be brought in a court of competent jurisdiction sitting in the State of Delaware.
3. Injunctive Relief. Because any breach of this Directive could result in irreparable harm not compensable by money damages, the parties acknowledge that injunctive relief is an appropriate remedy to enforce compliance.
4. Arbitration & Jury Trial. Arbitration and jury-trial waivers are not applicable to this Directive.

IX. GENERAL PROVISIONS

1. Amendment & Waiver. This Directive may be amended only by a written instrument signed and witnessed (or notarized) in compliance with the Act. No waiver of any provision shall be effective unless in writing.
2. Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force to the maximum extent permitted by law.
3. Copies. A photocopy or electronically transmitted copy of this Directive shall be as effective as an original.
4. Integration. This Directive constitutes the entire statement of Declarant’s health-care instructions and supersedes all prior inconsistent instruments.
5. Successors & Assigns. The rights and obligations hereunder shall bind and inure to the benefit of Declarant, Declarant’s heirs and estate, Agent, Alternate Agent(s), and all health-care providers.

X. EXECUTION BLOCK

A. Declarant Signature

I, [DECLARANT FULL LEGAL NAME], have read and understand this Directive and sign it as my free and voluntary act.

B. Witness Attestation

We declare that the Declarant signed or acknowledged this Directive in our presence, appears to be of sound mind, and is not executing under duress or undue influence. We are at least 18 years old, not named as Agent or Alternate Agent, not related to Declarant by blood, marriage, or adoption, and not entitled to any portion of Declarant’s estate. Only one witness may be an employee of a health-care provider caring for Declarant.

C. (Optional) Notarial Acknowledgment

State of Delaware )
: SS
County of [____] )

On this _ day of _, 20__, before me, the undersigned Notary Public, personally appeared [DECLARANT NAME], known to me or satisfactorily proven to be the person whose name is subscribed to this Directive, and acknowledged that he/she executed the same for the purposes therein contained.

Notary Public Signature: ____
Notary Name (Print): _____
My Commission Expires: ______

(Seal)

[// GUIDANCE:
1. Provide executed copies to the Agent, Alternate Agent(s), primary physician/APRN, and preferred hospital.
2. Upload to any available state or provider registries.
3. Review annually and upon major life events.]