Draft Advance Health Care Directive

Skill: Draft Advance Health Care Directive for Client with Early-Stage Alzheimer's Diagnosis

1. Subject-matter triage

• Treat the directive as the primary deliverable and the attorney memo as a companion advisory document.
• Read the intake packet for capacity findings, named decision-makers, prior instruments, privacy authorizations, donation preferences, witness candidates, and any emergency medical orders.
• If more than one decision-maker, prior instrument, or preference statement appears, enumerate each source and reconcile them before drafting.
• If the client’s instructions are clear and capacity-confirmed, the client’s expressed choices control; third-party preference does not override them.

2. Failure modes the skill is correcting

• Drafting from a single source without reconciling later instructions, prior documents, or intake discrepancies.
• Treating family pressure as a substitute for client instruction when capacity has been confirmed.
• Leaving vague treatment wishes in lay terms instead of converting them into clinician-usable standards.
• Collapsing distinct documents into one instrument, especially emergency medical orders, prehospital DNR forms, psychiatric directives, and privacy authorizations.
• Missing witness disqualification issues or other execution formalities that could impair validity.
• Failing to address whether prior healthcare-related powers of attorney are revoked, superseded, or left in effect.
• Leaving organ donation, whole-body donation, or end-of-life treatment preferences ambiguous.
• Using a divided authority structure that creates avoidable operational gaps between routine and major care decisions.

3. Legal frameworks / domain conventions that apply

• Controlling state directive statute: use the governing advance directive statute and execution rules for form, capacity, witnesses, revocation, and agent authority.
• Capacity standard: where a professional evaluation confirms the client can understand and communicate healthcare decisions, that confirmation supports execution; the document should reflect the client’s own instructions.
• Agent designation hierarchy: the most recent, clearly expressed, capacity-confirmed instruction governs over earlier inconsistent materials.
• Witness eligibility rules: interested persons, beneficiaries, or otherwise disqualified persons should not be used if the statute bars them.
• HIPAA coordination: agent appointment alone may not authorize disclosure; include or cross-check the privacy authorization required by the governing law or form.
• End-of-life clinical instructions: translate preferences for resuscitation, ventilation, and artificial nutrition/hydration into implementable medical directions tied to recognizable clinical states.
• Emergency-response separation: a general directive is not a substitute for prehospital medical orders or similar emergency-response instruments.
• Mental health treatment directives: if the jurisdiction recognizes a separate psychiatric directive, determine whether it is needed in addition to the general directive.
• Prior instrument coordination: address any prior durable power of attorney, prior directive, or related healthcare authorization so the new document does not create internal conflict.
• Donation choices: confirm whether the form allows one or both of organ donation and whole-body donation, and state the selection unambiguously.

4. Analytical scaffolds

1. Inventory the source set. List every place an agent, alternate agent, successor, privacy authorization, or treatment preference appears.
2. Reconcile conflicts. For each inconsistency, identify the earlier and later instruction, note the governing source, and state the resolution to be reflected in the draft.
3. Test execution validity. Confirm capacity, witness eligibility, and any required formalities before finalizing language.
4. Convert preferences into standards. Rewrite vague wishes into specific directions that clinicians can apply under defined medical conditions.
5. Separate related instruments. Determine whether the matter also needs a prehospital DNR, emergency medical order, psychiatric directive, or standalone HIPAA authorization.
6. Check authority allocation. Ensure the primary agent has a workable scope, successors are ordered, and day-to-day versus major decision authority is not needlessly split.
7. Address prior documents. State whether earlier directives are revoked, amended, or preserved, and identify any cleanup language needed.
8. Confirm donation and disposition instructions. Resolve any organ donation, body donation, autopsy, or similar end-of-life disposition election.
9. Pressure-test downstream use. Ask whether the resulting directive can be followed by hospitals, surrogates, and emergency personnel without requiring interpretation of intent.

5. Vertical / structural / temporal relationships

• Distinguish current, capacity-confirmed instructions from historical statements made before the diagnosis or before the latest evaluation.
• Distinguish healthcare decision authority from financial authority; do not assume overlap unless the source materials expressly create it.
• Distinguish routine care decisions from extraordinary or end-stage decisions, and specify when the agent may consent on the client’s behalf.
• Distinguish inpatient/provider-directed treatment from field emergency response, which may require separate documents.
• Distinguish appointment of an agent from authorization to access protected health information.
• Distinguish ordinary life-sustaining treatment choices from organ donation and whole-body donation elections.
• Distinguish revocation, amendment, and supersession of prior documents; use the correct cleanup language for each.

6. Output structure conventions

• Prepare the advance health care directive in the form required by the applicable jurisdiction, using plain, implementable clinical language.
• Include clear agent hierarchy, successor appointments, scope of authority, privacy authorization language if needed, and any required revocation or supersession clause.
• Include explicit treatment directions for resuscitation, ventilation, artificial nutrition and hydration, pain relief, comfort care, and other end-stage choices reflected in the source materials.
• If any issue cannot be resolved from the materials, leave it open in the memo and do not guess.
• Prepare the attorney cover memo as a short issue-by-issue advisory document that identifies each conflict, the resolution adopted, the governing authority, any execution concern, and any open item needing client confirmation.
• End the memo with specific recommended actions directed to the responsible role and tied to the execution or signing milestone.
• Produce the directive first and ensure it is complete and operative before finalizing the memo.
• Save the final deliverables as separate files named kowalski-advance-health-care-directive.docx and kowalski-attorney-cover-memo.docx.