# Draft Advance Health Care Directive > Drafting an advance health care directive for a client with diminishing capacity requires reconciling potentially inconsistent agent designations across source materials, translating abstract treatment preferences into actionable clinical standards, and addressing companion document requirements and professional responsibility concerns. - Skill: `finchipaiorg/draft-advance-health-care-directive` (Agent Skill) - Install (CLI): `npx skillmds@latest add finchipaiorg/draft-advance-health-care-directive` - Raw SKILL.md: https://api.skillmd.com/api/skills/finchipaiorg/draft-advance-health-care-directive/raw - Safety review: pending - Works with: Claude Code, Claude.ai, OpenAI Codex - Category: AI & ML - Author: FinchipAIOrg (https://skillmd.com/u/finchipaiorg) - Updated: 2026-09-22 - Page: https://skillmd.com/skills/finchipaiorg/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 - Failing to address whether prior healthcare-related powers of attorney are revoked, superseded, or left in effect.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`.