OREGON ADVANCE DIRECTIVE FOR HEALTH CARE

(Living Will & Appointment of Health Care Representative)

[// GUIDANCE: This template is drafted to comply with Oregon’s Health Care Decisions Act, OR. REV. STAT. §§ 127.505 et seq. (“ORS 127”). It is intentionally more comprehensive than the statutory short-form so that attorneys may tailor or delete provisions without jeopardizing statutory validity. Where the statutory form is mandatory, the operative language tracks ORS 127 verbatim and should not be altered except through the bracketed placeholders.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
    A. Appointment of Health Care Representative
    B. Health Care Instructions
    C. Organ, Tissue, and Body Donation
IV. Representations & Warranties
V. Covenants & Restrictions of Health Care Representative
VI. Default & Remedies; Provider Protections
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Revocation Procedures
XI. Execution Block (Signature, Witnesses/Notary)

I. DOCUMENT HEADER

1. Title. Oregon Advance Directive for Health Care (Living Will & Appointment of Health Care Representative).
2. Principal. [PRINCIPAL FULL LEGAL NAME], residing at [ADDRESS] (“Principal”).
3. Health Care Representative. [HCR FULL LEGAL NAME], residing at [ADDRESS] (“Health Care Representative” or “HCR”).
4. Alternate Representative(s).
   a. First Alternate: [ALT 1 NAME], residing at [ADDRESS].
   b. Second Alternate: [ALT 2 NAME], residing at [ADDRESS].
5. Effective Date. This Advance Directive (“Directive”) becomes effective upon proper execution pursuant to ORS 127 and remains in effect until revoked in accordance with Section X.

II. DEFINITIONS

For purposes of this Directive, capitalized terms have the meanings set forth below and apply throughout this document (alphabetical order).

“Advance Directive” or “Directive” means this written instrument executed pursuant to ORS 127. “Attending Physician,” “Health Care,” “Health Care Decision,” “Health Care Representative,” and “Life-Sustaining Treatment” carry the meanings assigned by ORS 127.505.

“Good Faith” means an honest belief, without malice or the intent to defraud, that a given action is lawful and appropriate under the circumstances.

“Principal” means the individual executing this Directive.

“Tube Feeding” means artificial or non-oral provision of nutrition or hydration through any tube or intravenous route.

[// GUIDANCE: Add or delete definitions to match additional client instructions, but do not delete statutory terms.]

III. OPERATIVE PROVISIONS

A. Appointment of Health Care Representative

1. Designation. Principal hereby designates the Health Care Representative named in Section I.3 to make any and all Health Care Decisions for Principal when Principal lacks capacity, to the fullest extent permitted by ORS 127.505-127.660, including but not limited to consent, refusal, or withdrawal of any treatment.
2. Alternates. If the primary HCR is unavailable, unwilling, or unable to serve, authority passes in the order listed in Section I.4.
3. Scope of Authority. HCR shall have authority to:
   a. Access medical records and information subject to HIPAA;
   b. Hire or discharge medical providers;
   c. Authorize admission to or discharge from health care facilities;
   d. Make decisions regarding Life-Sustaining Treatment and Tube Feeding as outlined in Section III.B;
   e. Take any actions consistent with the Principal’s expressed wishes herein;
   f. Petition a court for injunctive or declaratory relief to enforce this Directive.
4. Limitations. [PLACEHOLDER—for example, “HCR may not authorize psychosurgery.” If none, insert “None.”]

B. Health Care Instructions

[// GUIDANCE: The subsections below track the statutory form language. If the client prefers the short form, replace this subsection with the statutory checkbox form contained in ORS 127.531.]

1. End-Stage Condition. If the Attending Physician determines with a second physician’s concurrence that Principal is in a terminal condition and death is imminent even with treatment, Principal directs:
   ☐ Receive all available life-sustaining treatments.
   ☐ Receive life-sustaining treatments except: [SPECIFY].
   ☐ Decline life-sustaining treatments except comfort care.

2. Persistent Vegetative State. If Principal is permanently unconscious with no reasonable expectation of recovery:
   ☐ Receive all life-sustaining treatments.
   ☐ Receive life-sustaining treatments except: [SPECIFY].
   ☐ Decline life-sustaining treatments except comfort care.

3. Tube Feeding. If Tube Feeding would prolong life:
   ☐ Always administer.
   ☐ Administer unless [SPECIFY CONDITIONS].
   ☐ Do not administer.

4. Pain Management. Principal desires adequate pain relief even if it hastens death.
   ☐ Yes ☐ No ☐ Other: [SPECIFY].

5. Additional Instructions. [PLACEHOLDER—for example, “No blood transfusions.”]

C. Organ, Tissue, and Body Donation

1. Donation Election. Principal hereby:
   ☐ Donates any needed organs or tissues.
   ☐ Donates only the following: [SPECIFY].
   ☐ Declines to donate.
2. Anatomical Gift Purpose. ☐ Transplant ☐ Research ☐ Education ☐ Therapy

IV. REPRESENTATIONS & WARRANTIES

1. Capacity. Principal affirms being at least 18 years of age (or an emancipated minor) and of sound mind.
2. Voluntariness. This Directive is executed voluntarily, without duress, fraud, or undue influence.
3. Prior Directives. Any prior advance directive executed by Principal is hereby revoked.

V. COVENANTS & RESTRICTIONS OF HEALTH CARE REPRESENTATIVE

1. Fiduciary Duty. HCR shall act with Good Faith, diligence, and fidelity to the wishes of Principal.
2. Substituted Judgment. HCR shall make decisions in accordance with Principal’s known wishes and, if unknown, in Principal’s best interest.
3. Recordkeeping. HCR shall keep records of significant decisions and supply them upon reasonable request to interested persons.

VI. DEFAULT & REMEDIES; PROVIDER PROTECTIONS

1. Reliance on Directive. Any health care provider or facility may rely on a copy of this Directive that appears valid on its face.
2. Good Faith Immunity. Pursuant to ORS 127.555, a provider acting in Good Faith reliance on this Directive is immune from civil or criminal liability.
3. Judicial Relief. An interested person may petition the circuit court for:
   a. Enforcement, modification, or revocation of the HCR’s authority; or
   b. Injunctive relief to compel or prohibit treatment consistent with this Directive.

VII. RISK ALLOCATION

1. Indemnification of Providers. Principal agrees that, to the maximum extent permitted by law, providers complying in Good Faith with this Directive shall not be liable to Principal’s estate or heirs.
2. Liability Cap. Any civil liability of a provider acting under this Directive is limited to damages arising from gross negligence or willful misconduct, in accordance with ORS 127.555.

VIII. DISPUTE RESOLUTION

1. Governing Law. This Directive shall be interpreted and enforced under the laws of the State of Oregon, without regard to its conflict-of-laws rules.
2. Forum. Any action relating to this Directive shall be brought exclusively in the circuit court of the Oregon county where Principal resides or is receiving care.
3. Injunctive Relief. Nothing herein shall limit a party’s right to seek injunctive relief to prevent irreparable harm relating to Principal’s health care decisions.

IX. GENERAL PROVISIONS

1. Amendment. Principal may amend this Directive only by executing a new directive or a written amendment complying with ORS 127.515.
2. Waiver. Failure to enforce any provision does not waive future enforcement.
3. Severability. If any provision is held invalid, the remaining provisions remain in effect.
4. Integration. This Directive constitutes the complete expression of Principal’s instructions and revokes all prior directives and powers of attorney for health care.
5. Copies. A photocopy or electronically stored copy has the same effect as an original.
6. Electronic Signatures. If Oregon law is amended to permit electronic advance directives, an electronic signature that complies with such law shall be effective.

X. REVOCATION PROCEDURES

1. Method. Principal may revoke this Directive at any time by:
   a. A signed, dated writing expressing intent to revoke;
   b. Physically canceling, tearing, or otherwise destroying this Directive;
   c. An oral statement of intent to revoke in the presence of a witness 18 years or older.
2. Effectiveness. Revocation is effective upon communication to the Attending Physician or Health Care Provider.
3. Notice. Principal (or any person with knowledge of the revocation) should notify all known holders of copies, including the HCR, hospitals, and physicians.

[// GUIDANCE: Oregon law does not require a formal notice of revocation, but written proof minimizes disputes.]

XI. EXECUTION BLOCK

[// GUIDANCE: Oregon permits EITHER (i) two witnesses OR (ii) notarization. Do not use both.]

1. Principal’s Signature

______ Date: _______
[PRINCIPAL PRINTED NAME]
2. Witness Option

We declare under penalty of perjury that:
• We are at least 18 years old and competent.
• The Principal signed or acknowledged this Directive in our presence.
• We are not the Principal’s attending health care provider, HCR, or an employee of the provider facility.
• At least one of us is NOT related to the Principal by blood, marriage, or adoption and is NOT entitled to any portion of the Principal’s estate.

a. ____ ____ _
Witness #1 Printed Name Signature Date

b. ____ ____ _
Witness #2 Printed Name Signature Date
3. Notary Public Option (Use instead of witnesses)

State of Oregon )
County of __ )

On this _ day of _, 20___, before me, the undersigned Notary Public, personally appeared [PRINCIPAL NAME], personally known to me or proven on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument, and acknowledged executing the same.

Notary Public for Oregon
My Commission Expires: ____
Notary Seal
[// GUIDANCE: Attach HIPAA Authorization if broader disclosure is desired; file copies with primary care physician, local hospital, and each named HCR.]

END OF DOCUMENT