Advance Care Planning: Frequently Asked Questions

We hope the following FAQs will help you to start developing your own Advance Care Plan. 

The following FAQs provide basic information about the process of advance care planning and address issues to consider when developing your own plan. Links to expert local, state and national Advance Care Planning resources are available on the Resources page.

What is Advance Care Planning?

Advance Care Planning is a process that precedes development of a personal Advance Health Care Directive.
  • Advance Care Planning involves exploring your wishes, expressing your wishes, and preparing others to honor your wishes.
  • This is a conversation that takes place over time and is better done in the living room rather than under pressure in a hospital room.
Who Should You Talk to about Your Advance Care Planning Wishes? (Video: 1:52)

What is an Advance Health Care Directive?

An Advance Health Care Directive is a legal document that enables you to make your health care wishes known when you are no longer able to communicate your choices.
  • It allows you to specify what kinds of treatments you might want under certain circumstances.
  • It also allows you to name a willing person(s) — if you choose to do so — as your health care agent. This person would speak on your behalf and work with your doctor to make decisions about your care.
  • A completed directive is useful only if it is available when it is needed. It should be readily accessible and shared with your doctor and health care agent, not kept secret or stored away.
Although an Advance Health Care Directive is a legal document, you do not need an attorney to complete one. However, to make your directive legal, it needs to be to be signed by two witnesses or notarized by a licensed Notary Public. Witnesses cannot be your health care agent(s).

Because life is changing all the time, it’s important to regularly review and update your Advance Health Care Directive. Some people mark a memorable date on their calendars to review their directive annually.

Where do I find the Advance Care Directive form?

In California, there is no one required Advance Health Care Directive form. You will find many sources for the forms online. Check the links on the Resources page. You may want to review several to choose the one you like best. Many websites offer forms in English, Spanish, Chinese, and other languages.

What happens if I don't have an Advance Health Care Directive?

If you do not have a directive and become unable to speak in a medical situation, physicians will generally try to locate your family members, friends, or clergy to make decisions about your care. If physicians are unable to locate anyone willing to speak on your behalf, a hospital ethics panel or a court may make decisions for you.

How old should a person be to complete an Advance Health Care Directive?

Everyone age 18 or older needs an Advance Health Care Directive. No one can predict when accident or illness may leave you unable to communicate your choices to your loved ones and/or physician.

When would the provisions in my Advance Health Care Directive go into effect?

Most people choose to have their Advance Health Care Directives go into effect only if they lose the ability to communicate or understand decisions about their care. If you have a health care agent, you can choose to allow him/her to speak for you at any time, even if you can understand, make and communicate your own decisions.

What if I want to change my Advance Health Care Directive?

You have the right to revised your document whenever and as many times as you want. Simply complete a new document and destroy the old one. Your most recently dated directive is the one that is legally valid and will be acted upon. Make sure your loved ones, health care agent, physician(s) and caregiver(s) get a copy of the most recent version.

What is a health care agent?

A health care agent is someone over age 18 to whom you give the authority to make health care decisions on your behalf, should you become unable or unwilling to communicate for yourself. It is advisable, but optional, to name a health care agent (or two) in your directive.

Do I need to name a health care agent?

Selecting a health care agent is optional. However, if you have a relative or friend you believe would properly represent your wishes and he/she is comfortable serving in this role, it is highly advisable to name an agent in your directive. Some people choose an attorney or fiduciary for this role. Having a health care agent increases the likelihood that your wishes will be honored. If you do not name an agent, it is still important to complete a directive so you can document and share your wishes with your doctor.

Who Should You Talk to about Your Advance Care Planning Wishes? (Video: 1:52)

What is a POLST? Do I also need a "Do Not Resuscitate" form?

If you or your loved one has a chronic, progressive, serious health condition, is of advanced age or medically frail, a POLST may be appropriate. POLST is an acronym that stands for Physician's Orders for Life-Sustaining Treatment. Both you and your doctor must sign the completed POLST to make it legally valid. The POLST is recognized in health care systems throughout California. It is essentially a portable care plan that moves with an individual from one care setting to another. POLST is printed on bright pink paper to stand out. A POLST does not replace but complements an Advance Health Care Directive.

Contact Information

Sonoma Health Action

Contact us by Phone


1450 Neotomas Ave.

Suite 200

Santa Rosa, CA 95405

Advance Health Care Presentations

View these presentations for more comprehensive guidance:

Advance Care Planning Process Walk-through
(PDF: 784 kB)

How to Complete an Advance Health Care Directive
(PDF: 2.2 MB)