- Participating Physician Groups (PPG)
An advance directive is a formal document, written in advance of an incapacitating illness or injury in which one can assign decision-making for future medical treatment. California legally recognizes the durable power of attorney for health care (DPAHC) and the Natural Death Act declaration as advance directives for adults.
The DPAHC designates a person to make health care decisions if the principal becomes mentally incapacitated. The Natural Death Act allows an adult to sign a declaration declining life-sustaining treatment, including artificially administered nutrition and hydration, if the person becomes terminally ill or permanently unconscious.
According to AB 2805 (ch. 579, 2006), a written advance health care directive is legally sufficient if all the following requirements are satisfied:
- The advance directive contains the date of its execution
- The advance directive is signed either by the member or in the member's name by another adult in the member's presence and at the member's direction
- The advance directive is either acknowledged before a notary public or signed by at least two witnesses who satisfy the requirements of Sections 4374 and 4675 of the California Probate Code
- If the advance directive is acknowledged before a notary public, and a digital signature is used, the digital signature must meet all of the following requirements:
- It either meets the requirements of Section 16.5 of the Government Code and Chapter 10 (commencing with Section 22000) of Division 7 of Title 2 of the California Code of Regulations, or the digital signature uses an algorithm approved by the National Institute of Standards and Technology
- It is unique to the person using it
- It is capable of verification
- It is under the sole control of the person using it
- It is linked to data in such a manner that if the data are changed, the digital signature is invalidated
- It persists with the document and not by association in separate files
- It is bound to a digital certificate
For additional information on Advance Directive, refer to the member's Evidence of Coverage (EOC).
Complete documentation is essential whenever life-sustaining procedures are withheld or withdrawn, and must include:
- Member diagnosis and prognosis, including test results or other evidence for the attending physician's opinion and a second opinion confirming attending physician's conclusions
- Whether the member is likely to regain mental function and the facts on which determination of the member's mental incapacity was based
- A statement that the member or surrogate has been fully informed of the facts and the consequences of withholding or withdrawing life-sustaining procedures and that the surrogate decision-maker has consented to the withholding or withdrawing of such procedures
- A copy of any durable power of attorney for health care (DPAHC) declaration or non-statutory living will signed by the member
- Any desires verbally expressed by the member and a description of any discussion with family members or other surrogate
- A copy of a certified letter of guardianship or conservatorship (when one exists)
- Clear written orders to withhold or withdraw specific medical procedures