United States • State law varies • No national US medical POA
This is general legal information, not legal advice.

Medical Power of Attorney — Guide (US)

What it does • who can be your agent • how it is signed • what changes at the state line
Specialty: this page teaches the structure of a US medical power of attorney and the questions your own state’s statute answers — not one national rule, because there isn’t one.
Federal regulation defines an “advance directive” as a written instruction — such as a living will or durable power of attorney for health care — recognised under State law (42 CFR § 489.100). The federal government does not create the document. It defers to your state.
Jurisdiction — read this first
United States only, and we name no individual state’s rule. A US medical power of attorney has no legal effect in England & Wales, Scotland, Northern Ireland, Ireland, Australia or Canada. Scotland and Northern Ireland also differ from England & Wales, so there is no single “UK” equivalent.
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Agent choice
Signing checklist
State questions
Best for people saying:
  • “My parent goes into hospital next week.”
  • “I have a power of attorney — is that enough?”
  • “Can my spouse just decide for me?”
  • “The hospital won’t tell me anything.”
  • “I signed one years ago in another state.”
  • “Who can I name, and who can’t I?”

How this guide helps

Three steps — structure, then your state, then the signing.
1) Pick the right document
Naming a person and writing down treatment wishes are two jobs. Most people need both, and one document can often carry both.
2) Take the state checklist with you
Witnesses, notary, who is disqualified, whether an out-of-state document is honoured — you leave knowing exactly what to look up.
3) Sign it, then hand it out
A document nobody can find is a document that does not work.

What a medical power of attorney actually does

One job: it names a person.
It appoints an agent (some states say proxy or health care representative) to make health care decisions when you cannot. On the modern uniform pattern — the Uniform Law Commission’s Uniform Health-Care Decisions Act 2023, a model act that is law only where a legislature enacted it — the agent’s decision is effective without court approval, and the same document may also carry your treatment instructions.
“Health care decision” is broad: choosing or dismissing a doctor or facility; approving or refusing a test, procedure, medication or intervention; and directing that artificial nutrition or hydration, mechanical ventilation or other care be provided, withheld or withdrawn.
Federal law does not create your document. The Patient Self-Determination Act (Pub. L. 101-508, title IV, § 4206, 5 November 1990; 42 U.S.C. § 1395cc(f)) requires Medicare providers to give adults written information about their rights under State law, to record in a prominent part of your medical record whether you have a directive, not to condition care on having one, and to comply with State law. 42 CFR § 489.102 applies that to hospitals, skilled nursing and nursing facilities, home health agencies, hospices and others, and fixes when the information is handed over — at inpatient admission, at admission as a resident, before home care begins, at initial receipt of hospice care.

Your financial power of attorney does not cover health care

The most common and most expensive misunderstanding on this topic.
The Uniform Power of Attorney Act (2006), also a model act, applies to powers of attorney generally but expressly excludes a power to make health-care decisions (§ 103(2)). Its own comment to § 109 says the section does not empower the agent to make health-care decisions. Two documents, two jobs.
There is one overlap. Under § 109(d) a person you authorised in a financial power of attorney to determine your incapacity may act as your HIPAA personal representative to obtain health information and speak to your doctor. That is access to information, not authority to decide treatment.
HIPAA itself (45 CFR § 164.502(g)) requires a covered entity to treat your personal representative as you, and where a person has authority under applicable law to make health care decisions for an adult, the entity must treat them as personal representative for relevant information. The narrow exception at § 164.502(g)(5) lets an entity decline where it reasonably believes you have been or may be subjected to domestic violence, abuse or neglect by that person, or that treating them as representative could endanger you, and it judges that doing so is not in your best interest.

Choosing an agent — and how they must decide

The legal standard is stricter than “do what you think is best”.
  • The order they must follow. On the 2023 uniform pattern the agent owes a fiduciary duty and must follow your directions and your other goals, preferences and wishes so far as known or reasonably ascertainable. Only if those cannot be found does the agent use their own view of your best interest. That is why writing your wishes down matters as much as naming the person.
  • Commonly disqualified. Someone a court has found poses a danger to your well-being; and someone who owns, operates, works for or contracts with the nursing home or residential care facility where you live or are cared for — unless they are family, your cohabitant, or that cohabitant’s descendant.
  • When the power starts. Usually when you are found to lack capacity; it ceases if you regain capacity or object to the finding. Capacity is presumed unless a court finds otherwise or the presumption is rebutted on a contemporaneous clinical examination. Records access can be drafted to start on appointment instead.
  • Mental health limit. On the model, an agent may not consent to voluntary admission to a mental health facility unless the document specifically authorises it.
  • Co-agents. You can usually name more than one, plus alternates. Read the default: on the uniform pattern co-agents may each act independently unless you say otherwise.

Signing it: where state law bites hardest

A witness defect is discovered at the worst possible moment.
The 2023 uniform pattern requires the document to be in a record, signed by you, and signed by one adult witness who reasonably believes you are acting voluntarily and knowingly, and who is not the agent or the agent’s spouse, domestic partner or cohabitant — nor, if you live in or are cared for at a nursing home or other residential care facility, that facility’s owner, operator, employee or contractor. That model requires no notarisation, and treats a witness as present over real-time audio-and-video, or audio only where the witness knows you or can authenticate your identity.
None of that is necessarily your state’s rule. Witness count, whether a notary is needed instead of or as well as witnesses, whether facility staff may witness, whether there is a statutory form, and the minimum age all vary. Confirm before you sign.

If you name nobody, a statutory list decides

“My spouse will just decide” is an assumption, not a rule.
Where no agent is appointed or reasonably available, states use a default surrogate priority list. On the 2023 uniform pattern it descends: a person you identified outside a power of attorney; your spouse (or domestic partner), subject to divorce and separation exclusions; an adult child or parent; a cohabitant; an adult sibling; an adult grandchild or grandparent; an adult who routinely assisted your supported decision making in the last six months; a qualifying adult stepchild; then an adult who has shown special care and concern and knows your values.
These lists are among the most state-variable things in the whole area — the order differs and so does who is on it at all. Naming an agent removes the guesswork, and lets you choose someone the list would never reach. Related: on the uniform pattern a guardian may refuse to comply with or revoke your directive only if the appointing court expressly orders it, and unless a court orders otherwise, your appointed agent’s decision prevails over a guardian’s.

After you sign: copies, revoking, crossing a state line

The commonest failure is not a drafting error. It is a filing cabinet.
  • Copies count. Under the uniform pattern a physical or electronic copy of the directive or a revocation has the same effect as the original. There is no reason for the only copy to sit in a safe.
  • Hand it to the people who need it — your agent, your alternates, your regular doctor, any hospital or facility treating you. Providers must record whether a directive exists; they cannot record one they were never told about.
  • Revoking is deliberately easy — on the model, by any act clearly indicating the intention, including an oral statement to a health care professional, and a later conflicting directive revokes the earlier one to that extent. Still: revoke in writing, tell your doctor, collect old copies back.
  • Divorce removes a spouse-agent by default on the uniform pattern, once a petition for annulment, divorce, dissolution, legal separation or termination is filed and not dismissed or withdrawn, or a decree is issued — unless your document says otherwise.
  • Portability is itself a state question. The uniform rule honours a directive made elsewhere, but only helps in a state that enacted it. If you winter elsewhere or are treated across a state line, check.
  • Two federal limits misread as “they can ignore it”. Under 42 CFR § 489.102(c) a provider need not give care that conflicts with a directive, and need not implement one where as a matter of conscience it cannot and State law allows conscientious objection — which it must state clearly in its written policy.
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FAQ — medical power of attorney (US)

Tap to expand. State law varies throughout.
1) Is there one national US medical power of attorney?
No. Federal regulation defines an advance directive as an instruction recognised under State law. Every state has enacted some advance-directive statute, but their contents differ.
2) I have a durable power of attorney. Do I still need this?
Almost certainly. On the uniform financial-POA pattern, a power to make health-care decisions is expressly excluded. A financial POA may unlock your medical records — that is not authority to consent to or refuse treatment.
3) Can my spouse or next of kin just decide?
Only if your state’s default-surrogate statute puts them there, in that position, and only where no agent was appointed. Those lists vary a great deal between states.
4) Do I need a notary, witnesses, or both?
That is a state-law question and we will not guess it. The 2023 uniform model needs one qualifying adult witness and no notarisation — but it is a model, binding only where enacted.
5) Who can’t be my witness?
On the uniform pattern: the agent, the agent’s spouse, domestic partner or cohabitant, and staff of the care facility where you live. Your state may exclude more people.
6) When does my agent’s authority begin?
Typically when you are found to lack capacity, stopping if you regain it or object to the finding. Capacity is presumed. Records access can usually be drafted to start on appointment.
7) Can I name two agents?
Usually yes, plus alternates. Read the default: on the uniform pattern co-agents may each act independently unless your document says otherwise. If you want them to agree, say so.
8) How do I revoke it?
On the uniform pattern, by any act clearly indicating the intention, including an oral statement to a health care professional. In practice: revoke in writing, tell your doctor, collect the old copies.
9) Does it work if I move to another state?
Do not assume so. The uniform portability rule only helps in states that enacted it. If you move, spend part of the year elsewhere, or are treated across a state line, get it reviewed.
10) Can the hospital refuse to follow it?
Federal regulation says a provider need not give care that conflicts with a directive, and need not implement one where conscience prevents it and state law permits objection. Any such limit must be stated clearly in their written policy.
11) Does my agent get my medical records?
Where a person has authority under applicable law to make health care decisions for an adult, HIPAA requires the covered entity to treat them as your personal representative for relevant information — with a narrow abuse-and-endangerment exception.
12) Is this the same as a living will?
No. A living will records treatment wishes; a medical power of attorney names a person. Federal regulation lists both as examples of an advance directive, and modern forms often combine them.
13) Does it work in the UK, Ireland, Australia or Canada?
No. It has no legal effect there. Those jurisdictions use their own instruments and differ from each other, so there is no single “UK” document.
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This is general legal information, not legal advice. For advice on your situation, speak to a lawyer licensed in your state.