ADVANCE HEALTH CARE DIRECTIVE
(Living Will & Durable Power of Attorney for Health Care)
State of Idaho
[// GUIDANCE: This template integrates Idaho-specific statutory requirements for advance directives, including witness/notary, provider protection, revocation, and good-faith liability standards. Replace every [PLACEHOLDER] with client-specific information and delete any bracketed instructional text before finalization.]
TABLE OF CONTENTS
- I. Document Header
- II. Definitions
- III. Operative Provisions
3.1 Appointment of Health-Care Agent
3.2 Statement of Treatment Preferences (Living Will)
3.3 HIPAA Authorization
3.4 Delivery & Reliance - IV. Representations & Warranties
- V. Covenants & Restrictions
- VI. Default & Remedies
- VII. Risk Allocation
- VIII. Dispute Resolution
- IX. General Provisions
- X. Execution Block
I. DOCUMENT HEADER
1.1 Directive. This Advance Health Care Directive (the “Directive”) is made and entered into by [PRINCIPAL FULL LEGAL NAME], born [DOB], residing at [ADDRESS] (“Principal”), effective as of [EFFECTIVE DATE] (the “Effective Date”).
1.2 Governing Law. This Directive is governed by the laws of the State of Idaho relating to medical consent, natural death, and durable powers of attorney for health care (collectively, “State Health-Care Law”).
1.3 Purpose and Consideration. Principal executes this Directive voluntarily and for the purpose of:
a) designating one or more agents to make health-care decisions if Principal becomes unable to do so; and
b) memorializing clear instructions regarding end-of-life and other health-care preferences.
II. DEFINITIONS
[// GUIDANCE: Definitions appear alphabetically and apply uniformly throughout.]
“Advance Directive” means this Directive and any amendments or restatements hereof.
“Agent” means the individual appointed in Section 3.1 to make health-care decisions on behalf of the Principal.
“Alternate Agent” means the successor agent(s) named in Section 3.1.4.
“Artificial Nutrition and Hydration” means invasive feeding and fluid administration through intravenous, gastric, or other medical means.
“Attending Physician” means the physician who has primary responsibility for Principal’s care.
“Good Faith” means an honest belief in the propriety of a course of action after the exercise of reasonable diligence under the circumstances.
“Health-Care Decision” means any decision regarding the diagnosis, treatment, or care of Principal, including consent, refusal, or withdrawal of treatment.
“Health-Care Provider” includes any person or facility licensed, certified, or otherwise authorized by Idaho law to provide health-care services.
“Principal” has the meaning provided in Section 1.1.
III. OPERATIVE PROVISIONS
3.1 Appointment of Health-Care Agent
3.1.1 Primary Agent. Principal hereby appoints [PRIMARY AGENT NAME], whose contact information is [CONTACT INFO], as Primary Agent (“Agent”).
3.1.2 Scope of Authority. Agent may make any and all Health-Care Decisions the Principal could make, subject to limitations herein.
3.1.3 Effectiveness. Agent’s authority commences upon certification by the Attending Physician that Principal lacks capacity to make Health-Care Decisions.
3.1.4 Alternate Agent(s). If the Primary Agent is unable or unwilling to act, authority shall pass in the following order:
a) [ALTERNATE AGENT #1 NAME & CONTACT]
b) [ALTERNATE AGENT #2 NAME & CONTACT]
[// GUIDANCE: Delete b) if second alternate is not desired.]
3.2 Statement of Treatment Preferences (Living Will)
3.2.1 Terminal Condition or Persistent Vegetative State.
☐ I direct that life-prolonging treatment be withheld or withdrawn when the medical prognosis is incurable and death is imminent within reasonable medical judgment.
☐ I direct that life-prolonging treatment continue regardless of prognosis.
3.2.2 Artificial Nutrition and Hydration.
☐ I wish to receive artificial nutrition and hydration.
☐ I do not wish to receive artificial nutrition and hydration.
3.2.3 Pain Relief. I direct that medication be administered to alleviate pain or suffering, even if such medication may hasten death, provided it is consistent with standard medical practice.
3.2.4 Additional Instructions. [PLACEHOLDER for any spiritual, religious, or personal directives.]
3.3 HIPAA Authorization
The Agent and Alternate Agent(s) are “personal representatives” for purposes of the Health Insurance Portability and Accountability Act and may access Principal’s protected health information.
3.4 Delivery & Reliance
3.4.1 Copies: A copy or electronic facsimile of this Directive shall have the same effect as an original.
3.4.2 Reliance: Any Health-Care Provider or other third party acting in Good Faith may rely on the instructions of the Agent.
IV. REPRESENTATIONS & WARRANTIES
4.1 Principal represents and warrants that:
a) Principal is at least 18 years of age, of sound mind, and acting voluntarily;
b) Principal understands the contents and effect of this Directive and is not executing it under duress or undue influence; and
c) This Directive revokes any prior advance directive executed by Principal.
4.2 Agent Acceptance. By signing in Section 10, each Agent and Alternate Agent represents that he or she:
a) accepts the appointment;
b) will act in Good Faith and in the best interests of Principal; and
c) will comply with Idaho State Health-Care Law.
V. COVENANTS & RESTRICTIONS
5.1 Agent Covenants. The Agent shall:
a) consult, to the extent feasible, with medical professionals and family members;
b) honor Principal’s expressed Treatment Preferences;
c) maintain records of decisions made and the basis therefor; and
d) provide prompt written notice of any decision to discontinue life-prolonging treatment to the attending facility.
5.2 Limitations on Agent. The Agent may not:
a) authorize voluntary euthanasia or assisted suicide;
b) delegate the appointment power granted under this Directive; or
c) act contrary to Principal’s explicit written instructions herein.
VI. DEFAULT & REMEDIES
6.1 Removal of Agent. Upon petition by an interested party, a court of competent jurisdiction may remove an Agent who:
a) is unavailable, unwilling, or unable to act; or
b) has breached fiduciary duties or acted in bad faith.
6.2 Notice & Cure. Before petitioning for removal, the petitioner shall give written notice to the Agent and allow a five-day period to cure the alleged breach, unless immediate relief is required to prevent substantial harm.
6.3 Injunctive Relief. Any interested person, including Health-Care Providers, may seek temporary or permanent injunctive relief to enforce or prevent violation of this Directive.
6.4 Attorneys’ Fees. A prevailing party in any action to enforce this Directive shall be entitled to reasonable attorneys’ fees and costs.
VII. RISK ALLOCATION
7.1 Provider Protection & Indemnification. Principal agrees to indemnify and hold harmless any Health-Care Provider who, in Good Faith, follows the decisions of the Agent or the directives herein, from civil or criminal liability except for gross negligence or willful misconduct.
7.2 Limitation of Liability. No Agent or Health-Care Provider acting in Good Faith shall be liable for damages in excess of actual out-of-pocket costs directly related to any proven breach (“Good Faith Standard”).
7.3 Insurance. [OPTIONAL PLACEHOLDER] If Principal desires supplemental liability coverage for Agent(s), detail here.
7.4 Force Majeure. Health-Care Providers shall not be liable for inability to comply with this Directive due to acts of God, governmental orders, or other events beyond their reasonable control.
VIII. DISPUTE RESOLUTION
8.1 Governing Law. All matters arising under this Directive shall be governed by the laws of the State of Idaho, without regard to conflict-of-laws principles.
8.2 Forum. Any legal proceeding shall be brought in the state courts of [COUNTY], Idaho.
8.3 Arbitration & Jury Trial. Arbitration is not required. The right to jury trial is neither demanded nor waived by this Directive.
8.4 Injunctive Relief Preserved. Nothing in this Section limits a party’s right to seek injunctive or other equitable relief as provided in Section 6.3.
IX. GENERAL PROVISIONS
9.1 Amendment & Revocation.
a) Principal may revoke or amend this Directive at any time by:
(i) destroying or defacing the original;
(ii) executing a written revocation; or
(iii) orally expressing intent to revoke in the presence of an adult witness, followed by documentation in Principal’s medical record.
b) Any amendment or new directive must comply with Idaho witness or notary requirements.
9.2 Assignment. Rights and obligations hereunder are personal to Principal and may not be assigned.
9.3 Successors & Assigns. This Directive binds and benefits the heirs, executors, administrators, and permitted assigns of Principal.
9.4 Severability. If any provision is held invalid, the remaining provisions shall continue in full force to the maximum extent permitted.
9.5 Integration. This Directive constitutes the entire advance directive of Principal and supersedes all prior similar documents.
9.6 Counterparts & Electronic Signatures. This Directive may be executed in counterparts and by electronic signature, each of which is deemed an original.
X. EXECUTION BLOCK
10.1 Principal Signature
I, [PRINCIPAL NAME], have read and understand this Directive and sign it willingly.
______ ______
Principal Signature Date
10.2 Agent Acceptance
[// GUIDANCE: Have each Agent sign to evidence acceptance.]
Primary Agent:
______ ______
[PRIMARY AGENT NAME], Agent Date
Alternate Agent #1:
______ ______
[ALTERNATE AGENT #1 NAME], Alternate Agent #1 Date
Alternate Agent #2:
______ ______
[ALTERNATE AGENT #2 NAME], Alternate Agent #2 Date
10.3 Witness OR Notary (choose one)
OPTION A – TWO WITNESSES
We declare that the Principal signed or acknowledged this Directive in our presence and appears to be of sound mind and free from duress. We are not (i) appointed Agents herein, (ii) related to the Principal by blood, marriage, or adoption, nor (iii) an owner, operator, or employee of a health-care facility where the Principal is receiving care.
Witness #1:
Signature Date Printed Name & Address
Witness #2:
Signature Date Printed Name & Address
OPTION B – NOTARY PUBLIC
State of Idaho )
County of ___ ) ss.
On this ___ day of ____, 20__, before me, the undersigned, a Notary Public in and for said State, personally appeared [PRINCIPAL NAME], known to me (or proved to me on the basis of satisfactory evidence) 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 for Idaho
Residing at: ___
My commission expires: _____
[// GUIDANCE: Review Idaho Code before final execution to ensure no statutory updates affect witnessing, provider liability, or revocation procedures. Place completed originals in easily accessible locations and deliver copies to each Agent and primary health-care provider.]