Healthcare Agent Instruction Letter
Drafts a scenario-based, non-binding values letter in the client's voice to empower the health care agent and reduce ambiguity at the bedside. Output supplements—never replaces—operative legal directives.
Quick Start
- Confirm client identity, preferred name, and jurisdiction.
- Collect executed documents (name/date/type): health care POA or proxy, advance directive, POLST/MOLST, HIPAA release.
- Identify primary agent and alternates (full names, roles, contact preferences).
- Capture core values: quality-of-life thresholds, cognition-loss tolerance, dependence, pain, institutional care.
- Capture clinical preferences: CPR, ventilation, artificial nutrition/hydration, antibiotics, surgery, time-limited trials, hospice, comfort care.
- Capture spiritual/cultural commitments affecting care decisions.
- Identify conflict vectors and family communication plan.
- Capture tone preference, distribution timing, and document-storage locations.
- Never invent names, dates, diagnoses, or beliefs—ask for missing facts and use
[placeholder].
Core Workflow
| Phase |
Action |
Output |
| 1 |
Validate non-binding status |
Opening disclaimer: guidance only, not a substitute for operative directives |
| 2 |
Harmonize documents |
List governing document titles/dates; note instruction hierarchy |
| 3 |
Elicit decision framework |
Big-Three thresholds: cognition, independence, suffering |
| 4 |
Draft scenario logic |
Treatment sections with conditional "if/when…then…" examples |
| 5 |
Add faith/culture mechanics |
Practical care requests tied to beliefs, without legal overstatement |
| 6 |
Address conflict protocol |
Disagreement scripts, consult triggers, clinician communication |
| 7 |
Add logistics |
Distribution plan: who receives, when, storage locations |
| 8 |
Run quality controls |
Mismatch flags, ambiguity reduction, attorney-review gate |
Writing Constraints
- Client voice, plain language, short headings, 1–3 pages.
- Conditional framing throughout: "if/when…then…" with scenario examples.
- No medical orders or statutory language belonging in POLST/MOLST/clinic forms.
- Every section must be usable under stress by one reader in minutes.
Letter Template
Fill only known facts; use [placeholder] where missing.
Date: [date]
To: [Primary Agent], [Alternate(s)]
Re: My Values and Medical Decision Guidance
I wrote this letter to guide my agent if I cannot speak for myself.
I have executed [document names/dates]; this letter supplements and does not replace them.
1) Decision-Makers
- [Primary Agent], [Alternate Agent]
- Use substituted judgment: do what I would want, not what feels least difficult.
2) What Matters Most
- Good-day definition:
- Non-negotiable values/limits:
- Cognitive/function thresholds:
- Pain, comfort, dignity standards:
3) Treatment Preferences
- CPR / intensive care:
- Ventilation / breathing support:
- Feeding / hydration:
- Dialysis / infection treatment:
- Surgery / rehab vs. noninvasive care:
- Time-limited trials:
- Pain control / sedation:
- Preferred care setting:
4) Spiritual, Cultural, and Personal Preferences
- Practices/rituals:
- Clergy or contacts:
- Religious limits or accommodations:
5) Conflict and Communication
- Who should be included:
- Who may contest:
- Protocol: ethics/palliative consults, second opinions, family meeting trigger:
6) Closing
- Permission grant:
- Document storage locations:
- Distribution instructions:
Signature:
Post-Draft Checks
Jurisdictional Guardrails
| Topic |
Rule |
| Terminology |
Match client documents: "health care proxy," "medical power of attorney," "advance health care directive," etc. |
| POLST/MOLST |
Do not draft as an order form; recommend separate clinical workflow [VERIFY]. |
| Heightened-evidence jurisdictions |
Use heightened specificity where clear-and-convincing evidence may be required for life-sustaining-treatment disputes (e.g., In re Storar, 52 N.Y.2d 363 (1981)) [VERIFY]. |
| MAID |
Do not imply the agent can request aid-in-dying on the principal's behalf; separate statutory process [VERIFY]. |
| Default surrogacy |
Reference only client-selected legal chain; do not summarize statutes without attorney verification. |
Pitfalls
Do:
- Keep language operational: who, when, what threshold, what action.
- Preserve client's voice and style.
- Use
[placeholder] for all absent details.
- Require attorney review before final use.
Don't:
- Treat this as an enforceable legal order or substitute advance directive.
- Include medical advice or treatment guarantees.
- Create contradictions with signed legal documents.
- Use inflammatory family language that could weaponize disputes.
- Advise distribution to clinicians without confirming client disclosure preferences.
Attorney review is mandatory. Draft output is informational assistance only and does not constitute legal advice.
1---2name: healthcare-agent-instruction-letter3description: Drafts a non-binding healthcare values/instruction letter for a designated health care agent to guide substituted-judgment decisions during incapacity. Use when a client needs a bedside document that harmonizes with a health care power of attorney, healthcare proxy, or advance directive and captures quality-of-life thresholds, treatment preferences, and conflict guidance. Trigger on requests for "instruction letter," "health care agent letter," "values letter," "legacy letter," "healthcare proxy," or "DPOA health care."4---5
6# Healthcare Agent Instruction Letter
7
8Drafts a scenario-based, non-binding values letter in the client's voice to empower the health care agent and reduce ambiguity at the bedside. Output supplements—never replaces—operative legal directives.
9
10## Quick Start
11
121. Confirm client identity, preferred name, and jurisdiction.
132. Collect executed documents (name/date/type): health care POA or proxy, advance directive, POLST/MOLST, HIPAA release.
143. Identify primary agent and alternates (full names, roles, contact preferences).
154. Capture core values: quality-of-life thresholds, cognition-loss tolerance, dependence, pain, institutional care.
165. Capture clinical preferences: CPR, ventilation, artificial nutrition/hydration, antibiotics, surgery, time-limited trials, hospice, comfort care.
176. Capture spiritual/cultural commitments affecting care decisions.
187. Identify conflict vectors and family communication plan.
198. Capture tone preference, distribution timing, and document-storage locations.
209. Never invent names, dates, diagnoses, or beliefs—ask for missing facts and use `[placeholder]`.
21
22## Core Workflow
23
24| Phase | Action | Output |
25|-------|--------|--------|
26| 1 | Validate non-binding status | Opening disclaimer: guidance only, not a substitute for operative directives |
27| 2 | Harmonize documents | List governing document titles/dates; note instruction hierarchy |
28| 3 | Elicit decision framework | Big-Three thresholds: cognition, independence, suffering |
29| 4 | Draft scenario logic | Treatment sections with conditional "if/when…then…" examples |
30| 5 | Add faith/culture mechanics | Practical care requests tied to beliefs, without legal overstatement |
31| 6 | Address conflict protocol | Disagreement scripts, consult triggers, clinician communication |
32| 7 | Add logistics | Distribution plan: who receives, when, storage locations |
33| 8 | Run quality controls | Mismatch flags, ambiguity reduction, attorney-review gate |
34
35### Writing Constraints
36
37- Client voice, plain language, short headings, 1–3 pages.
38- Conditional framing throughout: "if/when…then…" with scenario examples.
39- No medical orders or statutory language belonging in POLST/MOLST/clinic forms.
40- Every section must be usable under stress by one reader in minutes.
41
42## Letter Template
43
44Fill only known facts; use `[placeholder]` where missing.
45
46```text
47Date: [date]
48To: [Primary Agent], [Alternate(s)]
49Re: My Values and Medical Decision Guidance
50
51I wrote this letter to guide my agent if I cannot speak for myself.
52I have executed [document names/dates]; this letter supplements and does not replace them.
53
541) Decision-Makers
55- [Primary Agent], [Alternate Agent]
56- Use substituted judgment: do what I would want, not what feels least difficult.
57
582) What Matters Most
59- Good-day definition:
60- Non-negotiable values/limits:
61- Cognitive/function thresholds:
62- Pain, comfort, dignity standards:
63
643) Treatment Preferences
65- CPR / intensive care:
66- Ventilation / breathing support:
67- Feeding / hydration:
68- Dialysis / infection treatment:
69- Surgery / rehab vs. noninvasive care:
70- Time-limited trials:
71- Pain control / sedation:
72- Preferred care setting:
73
744) Spiritual, Cultural, and Personal Preferences
75- Practices/rituals:
76- Clergy or contacts:
77- Religious limits or accommodations:
78
795) Conflict and Communication
80- Who should be included:
81- Who may contest:
82- Protocol: ethics/palliative consults, second opinions, family meeting trigger:
83
846) Closing
85- Permission grant:
86- Document storage locations:
87- Distribution instructions:
88
89Signature:
90```
91
92## Post-Draft Checks
93
94- [ ] Non-binding disclaimer appears in opening and closing.
95- [ ] No contradiction with operative legal documents; discrepancies flagged separately.
96- [ ] No invented facts; `[placeholder]` tags remain for missing data.
97- [ ] Treatment guidance is scenario-based, not slogans.
98- [ ] Conflict instructions protect agent authority consistent with legal appointment.
99- [ ] No absolute commands implying standalone legal effect.
100- [ ] Attorney-review gate and confidentiality note included.
101
102## Jurisdictional Guardrails
103
104| Topic | Rule |
105|-------|------|
106| Terminology | Match client documents: "health care proxy," "medical power of attorney," "advance health care directive," etc. |
107| POLST/MOLST | Do not draft as an order form; recommend separate clinical workflow [VERIFY]. |
108| Heightened-evidence jurisdictions | Use heightened specificity where clear-and-convincing evidence may be required for life-sustaining-treatment disputes (e.g., *In re Storar*, 52 N.Y.2d 363 (1981)) [VERIFY]. |
109| MAID | Do not imply the agent can request aid-in-dying on the principal's behalf; separate statutory process [VERIFY]. |
110| Default surrogacy | Reference only client-selected legal chain; do not summarize statutes without attorney verification. |
111
112## Pitfalls
113
114**Do:**
115- Keep language operational: who, when, what threshold, what action.
116- Preserve client's voice and style.
117- Use `[placeholder]` for all absent details.
118- Require attorney review before final use.
119
120**Don't:**
121- Treat this as an enforceable legal order or substitute advance directive.
122- Include medical advice or treatment guarantees.
123- Create contradictions with signed legal documents.
124- Use inflammatory family language that could weaponize disputes.
125- Advise distribution to clinicians without confirming client disclosure preferences.
126
127Attorney review is mandatory. Draft output is informational assistance only and does not constitute legal advice.
CaseMark