A Pennsylvania health care power of attorney is a signed document that names someone you trust to make medical decisions for you if you lose the ability to make or communicate them yourself. It takes effect only when you cannot decide on your own, and you can revoke it at any time while you still have the capacity to do so. The rules governing it sit in Title 20, Chapter 54 of the Pennsylvania Consolidated Statutes, alongside living wills and the state’s default surrogate rules.
How to Sign One That Will Hold Up
Pennsylvania requires three things: a mentally capable principal (the person creating the document), a signature, and two adult witnesses. You sign while you still understand what authority you’re giving away. If a physical limitation prevents you from signing, another person can sign for you, but only at your direction and in your presence.
The two witnesses sign to confirm you appeared to be of sound mind and were acting voluntarily. Two people are barred from serving as witnesses: the person you are naming as your health care agent, and anyone financially responsible for your medical care. That rule exists to keep obvious conflicts out of the room.
Notarization is not required. It’s still worth doing. A notarized signature is harder to dispute later, and some hospitals and care facilities accept a notarized document with less friction.
What Your Agent Can Decide
Your agent’s job is to decide the way you would decide, not to impose their own preferences. If your wishes aren’t clear from writings or past conversations, they must act in your best interest based on what they know about your values and beliefs.
The medical scope is broad:
- Consenting to or refusing surgery, medications, diagnostic tests, and other procedures.
- Deciding whether to continue, withhold, or withdraw life-sustaining treatment, including ventilators and feeding tubes.
- Admitting you to or discharging you from a hospital, nursing home, rehabilitation center, or hospice program.
- Accessing your medical records and speaking with your providers. Under federal HIPAA rules, an active health care agent is generally treated as your personal representative.1Health Information Privacy (HHS). Your Rights Under HIPAA
What your agent cannot do is touch your money. This is a medical document. Paying bills, handling bank accounts, and dealing with insurance claims require a separate financial power of attorney. The same person can hold both roles, but the two documents grant different authority and have to exist separately.
Choosing an Agent, and a Backup
The person matters more than the paperwork. Pick someone who can stay calm in a crisis, push back on doctors when needed, and set their own emotions aside long enough to carry out your wishes. Then name a successor. If your first choice is unavailable, out of the country, or dealing with their own health problems at the critical moment, a named backup keeps the document useful.
When It Takes Effect
Some health care powers of attorney are written to activate as soon as they’re signed. Others are “springing,” meaning the agent’s authority only starts after a physician certifies that you lack decision-making capacity. The distinction has practical consequences. A springing document can create delays during an emergency: someone has to reach a doctor, get a formal incapacity determination, and present it to the hospital before the agent can act. If you use a springing provision, make sure the triggering mechanism is spelled out clearly.
Capacity itself is presumed. Pennsylvania treats every adult as having the mental capacity to create a health care power of attorney unless someone proves otherwise.2Pennsylvania Department of Aging. Legal Requirements – POA and Other Advanced Directives That presumption can be rebutted, and challenges usually come from family members or providers who believe the principal was cognitively impaired at signing. If a challenge succeeds, the document is invalidated and decisions fall to a court-appointed guardian or the state’s default surrogate hierarchy. Signing while you are clearly competent is the way to avoid that fight.
How It Fits With a Living Will
Both are advance directives, but they do different jobs. The health care power of attorney appoints a person. A living will provides specific written instructions about end-of-life treatment, such as whether you want life-sustaining measures if you’re terminally ill or permanently unconscious. A living will becomes operative only after a copy reaches your attending physician and the physician determines you meet the qualifying conditions.3Pennsylvania General Assembly. Pennsylvania Code Title 20 Section 5443 – When Living Will Operative
When the two conflict, the living will’s explicit instructions control. If your living will says to withhold artificial nutrition in a terminal condition, your agent cannot override that and insist on a feeding tube. The agent’s authority fills the gaps a living will doesn’t reach, which in practice is most situations.
POLST Is Not the Same Thing
Pennsylvania also participates in the POLST program, which creates a medical order signed by a health care professional that emergency personnel can follow immediately.4Pennsylvania Department of Health. Pennsylvania Orders for Life Sustaining Treatment (POLST) A POLST contains specific orders about resuscitation, intubation, and other interventions; a health care power of attorney names a decision-maker. Paramedics and emergency room staff can act on a POLST because it is a physician’s order. They cannot act on a health care power of attorney the same way, because it is a legal document designating who decides, not an instruction telling them what to do.5National POLST. POLST and Advance Care Planning The Pennsylvania Department of Health recommends that anyone with a POLST also have a health care power of attorney in place.
Changing or Revoking It
You can revoke a Pennsylvania health care power of attorney at any time as long as you can express that intent. There is no required formality. You can do it in writing, state it out loud in front of witnesses, or physically destroy the document. What matters is that your intent to revoke is clear.
After revoking, notify everyone who has a copy: your former agent, your doctors, the hospital, any nursing facility, and family members who might present the old document. Providers can legally keep relying on a health care power of attorney until they actually learn it has been revoked. If you sign a new one, include a line explicitly revoking all prior versions.
After a Divorce
If you named your spouse as your agent and later divorce, don’t assume the old document is dead. Review it with an attorney and sign a new one naming someone else. This step is commonly overlooked, and the risk is serious: an ex-spouse could end up making life-or-death decisions if the old paperwork is still on file at the hospital.
What Happens If You Don’t Have One
Without a health care power of attorney, Pennsylvania law provides a default hierarchy of people who can step in as your health care representative, in descending order of priority:6Pennsylvania General Assembly. Pennsylvania Code Title 20 Section 5461 – Decisions by Health Care Representative
- Spouse (unless a divorce action is pending), along with any adult children who are not also children of the spouse
- Adult child
- Parent
- Adult sibling
- Adult grandchild
- An adult who knows your preferences and values, such as a close friend familiar with your religious and moral beliefs
The hierarchy works when family relationships are straightforward and everyone agrees. It breaks down in blended families, estranged relationships, or when several people at the same priority level disagree. Two adult children with opposite views can deadlock the process at the worst possible moment. Naming your own agent avoids that.
Making Sure Providers Actually See It
Pennsylvania has no central registry where hospitals check for advance directives. If the signed document is in a filing cabinet at home and you arrive at the emergency room unconscious, the medical team won’t know it exists. Give copies to your agent, your primary care doctor, any specialists you see regularly, and a trusted family member. Some people also carry a wallet card noting they have an advance directive and listing the agent’s contact information.
When you are admitted to a hospital, skilled nursing facility, home health agency, or hospice that participates in Medicare or Medicaid, federal law requires them to ask about your advance directives and to give you written information about your rights and the facility’s policies on honoring them.7Office of the Law Revision Counsel. 42 U.S. Code 1395cc – Agreements With Providers of Services A facility cannot condition your care on whether you have one, and cannot pressure you into signing as a condition of admission. If a provider will not honor your document, the law requires reasonable efforts to transfer you to one that will.
What It Costs
You can create a valid Pennsylvania health care power of attorney without an attorney using a standardized form. Pennsylvania’s statute includes a combined advance directive form covering both the health care power of attorney and a living will, and the state Department of Aging provides templates. These cost nothing beyond printing and, if you choose, a notarization fee.
If you hire an attorney, expect roughly $150 to $750, depending on whether the document is prepared on its own or bundled with other estate planning documents such as a living will, financial power of attorney, and basic will. A package is usually more cost-effective than paying for each piece separately. Either way, the price is modest compared to a guardianship proceeding, which can run into thousands of dollars in legal fees and take months to resolve.