Pennsylvania Healthcare Power of Attorney Requirements
Pennsylvania's Health Care Power of Attorney stands out for letting you override its own default timing: rather than automatically waiting on a physician's incompetence determination, you can state in the document itself that your agent, the person you name to make health care decisions for you if you're ever unable to make them yourself, gains authority the instant you sign.
Introduction
Pennsylvania's Health Care Power of Attorney stands out for letting you override its own default timing: rather than automatically waiting on a physician's incompetence determination, you can state in the document itself that your agent, the person you name to make health care decisions for you if you're ever unable to make them yourself, gains authority the instant you sign. It is created and governed by Pennsylvania's Health Care Agents and Representatives Act, 20 Pa.C.S. Chapter 54, Subchapter C, Sections 5451 through 5465. This document addresses only health care decisions. It does not cover financial matters like your money, property, or bills, which require a separate financial power of attorney. By default, your agent cannot start making decisions the moment you sign. Your agent's authority becomes operative only after a copy of the document is provided to your attending physician and that physician determines you are unable to make your own health care decisions, and that authority automatically pauses again if you later regain the ability to decide for yourself. Pennsylvania lets you change this default and state, right in the document, that you want your agent's authority to begin immediately instead. Pennsylvania requires you to sign the document, or direct another adult to sign for you, and have it witnessed by two adults who are each at least 18 years old. Notarization is optional, not required. Pennsylvania does not operate a state registry for these documents, so you simply keep the signed original and give copies to your physician, your agent, and any alternate agents.
Key Things to Know
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Pennsylvania offers no notary alternative for this document: it becomes valid only through two adult witnesses, and once witnessed, it lets you, the principal, name a trusted agent to make health care decisions for you if you're ever unable to make them yourself.
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By default, your agent's authority does not begin until a copy of the document is given to your attending physician and that physician determines you are unable to make your own health care decisions (20 Pa.C.S. Section 5454(a)); you can instead state in the document that your agent's authority begins immediately.
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Unless you limit it, your agent can make any health care decision you could make yourself, including consenting to, withholding, or withdrawing treatment, and, after your death, making anatomical gifts or directing disposition of your remains (Section 5456(a)).
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Unless related to you by blood, marriage, or adoption, your agent cannot be your attending physician, another health care provider, or an owner, operator, or employee of a facility where you receive care (Section 5455(b)).
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You must sign and date the document yourself, or direct another adult to sign for you in your presence, and have it witnessed by two adults who are each at least 18. Pennsylvania does not require notarization.
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You can revoke the document while of sound mind by a later, properly witnessed writing, or by personally telling your attending physician, health care provider, or agent that it is revoked (Section 5459).
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If your spouse is your agent and either of you files an action for divorce, your spouse's authority as agent ends automatically as of the filing date, unless your document states it should continue (Section 5430).
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Pennsylvania has no central state registry for Health Care Powers of Attorney. Keep the signed original and give copies to your physician, your agent, and any alternate agents.
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This is a different document from Pennsylvania's general power of attorney under 20 Pa.C.S. Chapter 56, which covers property and money, not health care, and which, unlike this document, is presumed durable by default and generally requires notarization.
Key decisions before you file
Before you file a Healthcare Power of Attorney in Pennsylvania, a few decisions shape the document: which option to choose and what each one means. The Healthcare Power of Attorney guide walks through them.
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Pennsylvania Requirements for Healthcare Power of Attorney
The health care power of attorney must identify the principal and appoint a health care agent (20 Pa.C.S. Section 5453(a)); Section 5455 lets the principal name one or more agents, with full name and contact information as shown in the statutory example form (Section 5471).
The principal may appoint one or more successor agents, who serve in the order named in the health care power of attorney unless the principal directs otherwise (Section 5455(a)(2)).
The agent has authority to make any health care decision and exercise any right or power regarding the principal's care, custody, and treatment that the principal could have exercised, including authorizing admission to a medical, nursing, or residential facility (Section 5456(a)); the agent also has the same rights as the principal to request, examine, and consent to disclosure of medical records (Section 5456(d)). The statutory example form additionally lists hiring and firing medical and support personnel among the agent's powers (Section 5471).
Federal HIPAA regulations govern how the agent can be authorized to access the principal's protected health information once the document is in effect.
Unless the document specifies otherwise, the health care power of attorney becomes operative only when a copy is provided to the attending physician and the attending physician determines the principal is incompetent, and it becomes inoperative again if the principal later regains competence (Section 5454(a), (b)). It remains valid until revoked by the principal, a court, or a court authorized guardian, regardless of how much time has passed, unless the document states its own termination date (Section 5454(d)). Unlike Pennsylvania's general power of attorney, which is presumed durable by default under Chapter 56 (Section 5601.1), the health care power of attorney is not presumed durable; Chapter 54 does not use durability language for it at all.
Incompetent means a condition in which an individual, despite being provided appropriate medical information, communication supports, and technical assistance, is documented by a health care provider to be unable to understand the potential material benefits, risks, and alternatives of a specific proposed health care decision, unable to make that decision, or unable to communicate it to another person; a person may be found incompetent for some decisions but competent for others (Section 5422).
The agent's authority to make health care decisions extends to life sustaining treatment decisions, subject to the pregnancy provisions (Section 5429), the effective date rules (Section 5454), and the attending physician's duties (Section 5462(a)); the agent's authority can also extend beyond the principal's death to make anatomical gifts, authorize an autopsy, and direct disposition of remains (Section 5456(a)).
The health care agent's authority may extend beyond the principal's death to make anatomical gifts, dispose of the principal's remains, and consent to autopsies (Section 5456(a)). The statutory example form lets the principal separately elect to donate organs, tissue, or eyes and to donate hands, facial tissue, limbs, or other vascularized composite allografts, each requiring explicit and specific consent (Section 5471).
This subchapter does not affect the requirements of other Pennsylvania laws regarding consent to observation, diagnosis, treatment, or hospitalization for mental illness (Section 5463(a)); a health care agent's authority to consent to inpatient psychiatric treatment on the principal's behalf is therefore governed by the Mental Health Procedures Act and related law, not by this health care power of attorney statute alone.
Life sustaining treatment, nutrition, and hydration must be provided to a pregnant patient who is incompetent and has an end-stage medical condition or is permanently unconscious, notwithstanding a living will, health care decision, or advance directive to the contrary, unless the pregnant patient's attending physician and an examining obstetrician certify in the medical record that the treatment will not permit continuing development and live birth of the unborn child, will be physically harmful to the pregnant patient, or will cause pain that cannot be alleviated by medication (Section 5429(a), (b)).
An individual of sound mind may make a health care power of attorney only if 18 years of age or older, a high school graduate, married, or an emancipated minor (Section 5452(a)). The document must be dated and signed by the principal, or signed by another individual on the principal's behalf and at the principal's express direction if the principal cannot sign, and witnessed by two individuals each 18 or older (Section 5452(b)).
A person who signs the health care power of attorney on the principal's behalf and at the principal's direction may not also serve as a witness, and a health care provider or its agent may not sign on the principal's behalf if that provider or agent is providing the principal health care services (Section 5452(c)). Chapter 54 does not bar the health care agent, the principal's physician, or a facility owner or employee from serving as an ordinary witness when the principal signs personally; the statutory example form only states it is preferable, not required, that witnesses not be the principal's heirs, creditors, or health care provider employees (Section 5471).
Notarization of a health care power of attorney is not required by Pennsylvania law; Section 5452's execution requirements list only dating, signing, and two witness attestation, with no notary option or requirement anywhere in Subchapter C. The statutory example form makes this explicit, labeling its notary block optional and noting it may make the document more likely to be honored under other states' laws (Section 5471).
While of sound mind, the principal may revoke a health care power of attorney by a writing executed in accordance with Section 5452 or by personally informing the attending physician, health care provider, or health care agent that it is revoked; a provider may rely on the document's effectiveness until notified of revocation, and an agent who knows of the revocation may not make or attempt to make health care decisions for the principal (Section 5459(a), (b), (c)).
After consulting health care providers and gathering the required prognosis information, the agent must make health care decisions according to the agent's understanding of instructions the principal gave while competent; in the absence of instructions, the agent must decide according to the principal's known preferences and values, including religious and moral beliefs, or, if those are unknown, the principal's best interest (Section 5456(c)(4), (5)).
A health care provider or other person is protected from criminal or civil liability, professional discipline, or administrative sanction for actions such as complying in good faith with an agent's or representative's health care decision, or refusing to comply based on a good faith belief the individual lacks authority (Section 5431(a)); no health care agent acting in good faith for a principal is subject to civil or criminal liability for acting, or for failing to act, in good faith (Section 5431(c)).
Facilities that participate in Medicare and Medicaid must inform patients of their rights under state law to make advance directives, including a health care power of attorney.
This subchapter does not prevent a health care agent from consenting to health care administered in good faith under the principal's religious beliefs, or from withholding consent to health care that is contrary to those beliefs (Section 5463(d)); in the absence of clear instructions, the agent must also take the principal's religious and moral beliefs into account when assessing the principal's preferences, values, and best interest (Section 5456(c)(5)).
If a principal who has executed a health care power of attorney is later adjudicated incapacitated and a guardian of the person is appointed, the health care agent is accountable to the guardian as well as to the principal, and the court determines the extent to which the agent's authority remains in effect; the principal may also nominate a guardian of the person in the document itself for the court's consideration if incapacity proceedings are later commenced, typically nominating the health care agent as the preferred guardian (Section 5460(a), (b)).
A health care power of attorney executed in another state or jurisdiction, and in conformity with the laws of that state or jurisdiction, is considered valid in Pennsylvania, except to the extent it would allow a health care agent to make a health care decision inconsistent with Pennsylvania law; this section also preserves the validity of a power of attorney executed before Chapter 54's effective date (Section 5464).
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Check my Healthcare Power of AttorneyFrequently Asked Questions
A Health Care Power of Attorney in Pennsylvania is a legal document, created under 20 Pa.C.S. Chapter 54's Health Care Agents and Representatives Act, that lets you name a trusted adult, your agent, to make health care decisions for you if you ever become unable to make them yourself. It covers only health care decisions, such as consenting to or withholding treatment, and its authority typically waits until your attending physician determines you are unable to decide for yourself, unless you state in the document that you want it to begin immediately.
A Health Care Power of Attorney covers only health care decisions. Pennsylvania's general power of attorney, under 20 Pa.C.S. Chapter 56, covers property and financial matters instead, such as banking or real estate, and it is presumed durable by default, meaning it survives your incapacity unless the document says otherwise. The Health Care Power of Attorney has no such presumption; it typically becomes operative only once your attending physician determines you are unable to decide for yourself, though you can choose immediate effectiveness instead. Execution also differs: the general power of attorney generally requires notarization plus a statutory notice and agent acknowledgment, while the Health Care Power of Attorney only requires two witnesses and no notary.
No. Pennsylvania law does not require notarization for a Health Care Power of Attorney. You need only sign and date the document and have it witnessed by two adults who are each at least 18 years old (20 Pa.C.S. Section 5452). Notarizing the document anyway is not required, but it may make the document more likely to be honored if you need care in another state.
Pennsylvania requires two witnesses, each at least 18 years old, and the law does not bar your health care agent, your doctor, or a care facility's owner or employee from serving as a witness when you sign the document yourself (20 Pa.C.S. Section 5452(b), (c)). The only witness restriction applies when someone else signs the document on your behalf: that proxy signer cannot also serve as a witness, and a health care provider who is treating you cannot sign on your behalf at all.
Generally, no. Unless that person is related to you by blood, marriage, or adoption, your attending physician or other health care provider, and the owner, operator, or an employee of a health care provider where you are receiving care, cannot serve as your health care agent (20 Pa.C.S. Section 5455(b)).
No. Pennsylvania does not operate a central advance directive registry. You keep the signed original yourself and give copies to your physician, your agent, and any alternate agents so they have it when needed.
While you are of sound mind, you can revoke your Pennsylvania Health Care Power of Attorney by signing a new writing executed the same way as the original, or by personally telling your attending physician, health care provider, or agent that you are revoking it (20 Pa.C.S. Section 5459). Simply telling a family member, without more, does not revoke the document.
Generally, no. Pennsylvania's Health Care Agents and Representatives Act does not give a health care agent authority over decisions that other state laws govern, such as consent to inpatient psychiatric treatment; those decisions remain governed by Pennsylvania's Mental Health Procedures Act and related law (20 Pa.C.S. Section 5463(a)).