ADVANCE DIRECTIVES FY 2024-2025
ADVANCE DIRECTIVES-HEALTHCARE DECISION MAKERS – MANDATORY COMPETENCY – FY 2024-2025
Objective:
To understand who may make healthcare decisions for a patient who lacks the
capacity to speak for themselves.
Relevant Policy:
TUH INC-ADMIN-950.2024 Patient Self-Determination: Advance Directives
Tutorial:
Temple University Hospital, Inc. and its’ Temple University Health System affiliates support a
patient’s right to participate in healthcare decision making.
Capacity: A patient is deemed to have capacity when they understand the potential significant
benefits, risks and alternatives involved in a proposed treatment plan. The patient has the
capacity if they can communicate their understanding to the healthcare provider. A patient is
presumed to have the capacity to make their own medical decisions. In the event that a patient
lacks capacity to make decisions about their own healthcare there are certain types of healthcare
decision makers who may represent the interests of the patient.
Agent: An Agent is someone that is selected in writing by the patient when the patient has the
capacity to make the selection. The written document is called a Health Care Power of Attorney.
The Agent can make any healthcare decision the patient would be able to make when they had
capacity. This authority includes the refusal of life sustaining medical care. An Agent may direct
the withdrawal or withholding of medical care. The agent must always act in the best interests of
the patient. A patient who has capacity may revoke or modify the appointment of the Agent.
Guardian: A Guardian is someone who is appointed by the Court to make decisions for a person
who lacks capacity. A Guardian does not have the authority to refuse life sustaining medical
care.
Health Care Representative: This person must be at least eighteen years old and may make
decisions for a patient whose Doctor has determined that they lack decision-making capacity.
Health Care Representatives may be used as medical decision makers after it has been
determined that no Agent or Guardian has been appointed or that they are not reasonably
available. The following people in descending order may act as health care representatives:
1. Spouse (unless an action for divorce is pending in Court)
2. An adult child
3. A parent
4. An adult brother or sister
5. An adult grandchild
6. An adult who has knowledge of the patient’s preferences and values, including
but not limited to religious and moral beliefs and who knows how the patient
would make health care decisions for themselves.
It is important to note that Legal Guardians and Healthcare Representatives may not withdraw or
withhold medical care unless the patient is permanently unconscious or is suffering from an end
stage medical condition. Either of those two conditions must be verified by two physicians. If a
patient regains capacity the Health Care Representative can no longer make their decisions.
