Health Care Proxy
(Long Form) (DC)

Summary

This template is a long-form health care proxy for use in the District of Columbia to appoint an agent to make decisions regarding the principal's health care in the event that the principal becomes incapacitated and unable to make the decisions for himself or herself. This template includes practical guidance, drafting notes, and alternate and optional clauses. This is a long-form advance directive, containing both health care proxy and living will language setting forth the principal's wishes concerning life-sustaining and other medical treatment. Note that the long form health care proxy contains a provision stating that in the event of any apparent conflict between the expression in the health care proxy of the principal's wishes and the health care agent's good faith decision, the latter will govern. Use of the long-form may be a convenience because health care providers are required to ask patients if they have executed advance directives (living wills or health care proxies) and to note patients' answers in their medical records. See 42 U.S.C. § 1395cc(f). Any written form that meets the requirements set forth in D.C. Code § 21-2205 may be used to create a durable health care proxy. See D.C. Code § 21-2207. The District of Columbia Official Code provides a very basic example health care proxy form at D.C. Code § 21-2207. The statutory form is an example only and does not preclude the use of more expansive language, such as that found in this template. This template meets the statutory requirements to create a durable health care proxy pursuant to D.C. Code § 21-2205. This template does NOT function as “Medical Orders for Scope of Treatment (MOST)” directive or a “Request for Medication to End My Life in a Humane and Peaceful Manner” directive under the District of Columbia Death with Dignity Act of 2016 (D.C. Code § 7-661-01 et seq.) Unlike a health care proxy or living will, these require physician consult and participation. The MOST form is a set of medical orders and may be signed by either the patient or his or health care agent. The latter requires the individual be mentally capable of making their own health care decisions and take certain proscribed steps to request and receive a doctors’ prescription. This template does not address property or financial matters. For a power of attorney form that may be used in the District of Columbia, see Power of Attorney (Durable, General) (DC). For related documents, see Will for Single Individual (Optional Trust(s) for Children) (DC), Will for Individual with Spouse or Partner (Optional Trust(s) for Spouse/Partner and/or Children) (DC), and Standby Guardian Designation (DC). For a list of key resources that address healthcare advance planning topics, see Healthcare Advance Planning Resource Kit.