Institute For Ethics

Advance Directive

An Advance Healthcare Directive Form lets you give instructions about your own health care and/or name someone else (an agent) to make health care decisions for you if you become unable to make your own decisions. You may fill out some or all of this form. You may change all or any part of it, or use a different form. If you have already signed a durable power of attorney for health care and/or a right-to-die statement (living will), these are still valid. If you wish to combine the health care instructions found in these documents, you may use this optional form.

Please feel free to print and fill out this form making sure to sign and date it. You have the right to revoke (cancel) or replace this form at any time. Give copies of this signed form to your health care providers and institutions, any health care agents you name, and your family and friends.

THIS FORM IS OPTIONAL. You do not have to use any form; instead, you may tell your doctor whom you want to make health care decisions for you. If you have not signed a form or told your doctor whom you want to make your health care decisions, New Mexico law allows these people, in the following order, to make your health care decisions (if these people are reasonably available):

• 1) spouse
• 2) significant other
• 3) adult child
• 4) parent
• 5) adult brother or sister
• 6) grandparent
• 7) close friend.

You may name another person as your agent to make health care decisions for you if you become incapable of making your own decisions. This is called a durable power of attorney for health care. You should talk to the person you name as agent to make sure he or she understands your wishes and is willing to act as your agent. You may also name alternative agents if your first choice cannot or will not make health care decisions for you. Unless related to you, your agent may NOT be an owner, operator or employee of a health care institution at which you are receiving care. This form has a place for you to limit the authority of your agent. If you do not limit your agent's authority, your agent may make all health care decisions for you.

This form is not copyrighted; you may make as many copies as you wish.