One of the most important things you can do as part of your estate planning is authorizing someone to make decisions on your behalf in the event you become incapacitated and can’t make decisions for yourself anymore. This person whom you authorize is called your agent. You can provide your agent with specific instructions you wish to have carried out on your behalf should you ever need the agent to act for you.

Without such authorization and instruction, you’ll often be required to go to court in order to have a judge appoint someone to legally make these decisions for you. For any financial decisions you may need help with, you can appoint someone to make these decisions for you with a power of attorney, or by putting your assets in a trust. For your medical and health care decisions, you can appoint an agent with a document called an advance health care directives (“AHCD”).

An AHCD will allow you to designate an individual, or individuals, as agent to make necessary health care decisions for you. This document typically will allow a doctor or hospital to consult with the agent you name about appropriate treatments, prescriptions, surgeries, medications, and rehabilitation which may be available for you. In addition, an AHCD allows you to make end-of-life decisions ahead of time. Your AHCD will let you decide whether or not you want to prolong your life with life support, including artificial nutrition and hydration, which will become effective if your doctor ever determines there is nothing which can be done to improve your condition and that you will likely pass away soon. You can also decide if pain medication can be given to you even if the pain medication might shorten your life.

The AHCD is a very useful and helpful document to create during your life. The AHCD, however, is not the only medical authorization document you need to consider. In Hawaii, you may also create a Provider Orders for Life Sustaining Treatment (“POLST”). This document is typically obtained through your primary care physician but can also be obtained through your estate planning attorney or online. This document allows you to provide significantly more details about your desired end-of-life care and can account for situations before an AHCD becomes effective. The POLST is typically a bright green document and should be placed in a readily accessible place at home like on the refrigerator or the inside of your door.

The POLST allows you to decide whether or not you wish to receive resuscitation (sometimes referred to as a DNR – do not resuscitate) if you are ever without a pulse. The POLST also allows you to decide on the types of medical interventions you wish to receive ranging from “Comfort Measures Only” to “Full Treatment”. You should consult with your physician about the differences in these types of medical treatments. Similar to the AHCD, the POLST allows you to decide on whether you wish to receive any artificial nutrition and hydration but unlike the AHCD, it allows you to potentially limit or expand this treatment by specifying a purpose for this type of treatment. For more information on POLST, see this link: https://www.kokuamau.org/professionals/polst

Finally, even though your agent will have authority under Hawaii State law to act and make decisions for your health care on your behalf with an AHCD, under federal law your doctors may not have authority to release your medical information to your agent. This is why it’s also important to have a HIPAA Authorization (Health Insurance Portability and Accountability Act of 1996). The HIPAA Authorization allows your doctor and other health care providers to release protected medical information to your agent.

A complete estate plan should include all three of an AHCD, a POLST, and a HIPAA Authorization. These documents, along with your other estate planning documents should be re-visited and updated at least every few years if not every year.


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Ethan R. Okura received his Doctor of Jurisprudence Degree from Columbia University.

Carroll (Cary) D. Dortch received his Doctor of Jurisprudence Degree from the University of New Hampshire School of Law, and clerked for the Honorable Judge David G. Campbell in Arizona.

The lawyers at Okura & Associates focus their practice on Estate Planning to protect assets from nursing home costs, probate, estate taxes, and creditors.

This column is for general information only. The facts of your case may change the advice given. Do not rely on the information in this column without consulting an estate planning specialist.