New York Healthcare Directive Guide

A New York healthcare directive lets you decide who speaks for your medical care, and what care you want, before a health crisis takes that choice away. New York builds this around the Health Care Proxy, which names a trusted person to make decisions when you cannot. You can also leave written health care instructions, and serious-illness medical orders can go on a MOLST form when a clinician is involved.

This guide walks through each document, how to sign one that holds up, and when your choices take effect.

What These Documents Do

New York handles health care decision-making mainly through Public Health Law Article 29-C. Here is how the pieces fit together.

Health Care Proxy (Public Health Law Article 29-C)

This is New York's primary planning document. It names a health care agent to make medical decisions for you once a doctor decides you cannot make them yourself.

Your agent can:

Make any health care decision you could make, subject to the proxy and New York law
Receive the medical information and records needed to make informed decisions
Apply your wishes and religious or moral beliefs when those are known
Decide based on your best interests when your wishes cannot reasonably be known

Your agent faces two limits worth knowing:

The agent can decide about artificial nutrition and hydration only if the agent knows your wishes about those measures or can find them out with reasonable diligence.
The proxy cannot authorize anything you could not legally consent to yourself.

Living Will or Written Health Care Instructions

New York recognizes that adults can write down their wishes about treatment, including life-sustaining treatment, even apart from a proxy. New York does not provide a single statutory living-will form, so these instructions should be written clearly and shared with your agent and your doctors. Written wishes do not cancel a Health Care Proxy unless they say so directly. They stand as evidence of what you want.

MOLST (Medical Orders for Life-Sustaining Treatment)

MOLST is a medical order form for people with serious health conditions. A clinician completes it after a discussion with you, your agent, or your surrogate, and it records orders about CPR and other life-sustaining treatment. MOLST is the authorized New York form for documenting both a nonhospital DNR and a nonhospital DNI order. It is a clinical process, not a do-it-yourself form.

Who Can Create One

To sign a Health Care Proxy in New York, you must:

Be a competent adult, age 18 or older
Understand what the document does
Sign willingly and free from duress

You do not need to be a New York resident. If you spend real time in New York, a New York proxy helps your care team act without delay.

How to Create a Health Care Proxy

Here is the path from start to signed document.

Step 1: Choose your agent. Pick someone you trust to follow your wishes under pressure. Name an alternate agent in case your first choice cannot serve. Some people cannot serve as your agent, including, in most cases, an operator, administrator, or employee of a hospital where you are or may become a patient, unless a narrow exception applies.

Step 2: Set the scope. You can give broad authority or add limits. If you want to guide or restrict decisions about artificial nutrition and hydration, address that clearly, because your agent's authority over those measures depends on knowing your wishes.

Step 3: Sign with two witnesses. Sign and date the proxy, or have someone sign at your direction and in your presence. Two adult witnesses then sign and confirm that you appeared to act willingly and free from duress. Your chosen agent cannot serve as a witness. New York also allows an audio-video witnessing procedure when the conditions in Public Health Law 2981 are met.

Step 4: Skip the notary. New York does not require notarization for a Health Care Proxy.

Signing Requirements for a Health Care Proxy

Requirement	Details
Principal's signature	Required (or signed at your direction, in your presence)
Witnesses	2 adult witnesses required
Agent as witness	Not allowed
Notarization	Not required
Attorney	Not required

Living Will and Written Instructions

New York does not give you a fill-in statutory living will. Write your instructions in plain language, state your preferences about life-sustaining treatment, and share copies with your agent and your doctors. Clear, specific wishes give your agent and care team the evidence they need.

When Your Proxy Takes Effect

Your proxy stays inactive while you can make your own decisions. Here is what activates it.

Your attending practitioner decides, to a reasonable degree of medical certainty, that you lack capacity to make health care decisions.
That determination goes in your medical record in writing.
For a decision to withhold or withdraw life-sustaining treatment, the attending practitioner consults another physician, physician assistant, or nurse practitioner to confirm the capacity finding.
Your agent's authority begins, and continues while you lack capacity.

Special capacity rules apply when incapacity stems from mental illness or developmental disability, and additional consultation steps can be required under Public Health Law 2983.

Medical Records Access

Once your agent's authority begins, the agent can receive the medical information and clinical records needed to make informed decisions. Telling your agent and your primary doctor about the proxy ahead of time helps avoid delays at the hospital.

Special Rules to Know

No agent? New York names a surrogate. When an adult patient lacks capacity and no health care agent is available, the Family Health Care Decisions Act lets a surrogate decide, under Public Health Law 2994-D. New York sets this priority:

A guardian authorized to decide about health care under Mental Hygiene Law Article 81
A spouse, if not legally separated, or a domestic partner
An adult son or daughter
A parent
An adult brother or sister
A close friend

A valid Health Care Proxy agent's decisions take priority over these surrogates, except as the proxy or Article 29-C provides.

Artificial nutrition and hydration. Your agent can decide about feeding tubes and IV fluids only when the agent knows your wishes or can find them out with reasonable diligence. Spell out your preferences so this is not left to guesswork.

Remote witnessing. New York permits audio-video witnessing of a Health Care Proxy when the Public Health Law 2981 conditions are met.

Out-of-state proxies. Article 29-C includes rules for recognizing proxies signed in other states.

How to Update or Revoke

You can change or cancel your Health Care Proxy at any time while you have capacity (Public Health Law 2985).

Tell your agent or a health care provider, in words, in writing, or by any act that shows you intend to revoke
Sign a later Health Care Proxy, which cancels the earlier one
Know that divorce or legal separation cancels the appointment of a spouse-agent, unless you state otherwise

To update written instructions, put the change in writing and share it with your agent and doctors. To change MOLST orders, your clinician follows current New York Department of Health MOLST steps to void and replace them.

Common Mistakes

Naming the wrong agent. Choose someone who will carry out your wishes, not substitute their own. The job calls for someone steady under stress.

Leaving feeding and fluids unaddressed. If your agent does not know your wishes about artificial nutrition and hydration, the agent's authority over those measures is limited. Write your preferences down.

Telling no one. A proxy helps only if people can find it. Give copies to your agent, your family, and your primary care doctor.

Treating MOLST as a planning form. MOLST is a medical order signed by a clinician for people with serious illness. It does not replace a Health Care Proxy.

Assuming an out-of-state form is enough. New York may recognize an out-of-state proxy, but a New York proxy removes the guesswork if you live in or spend a lot of time in New York.

Signing without talking. The form is half the job. Sit down with your agent and explain your values, fears, and wishes so the agent can speak for you with confidence.

How This Fits Into Your Estate Plan

A healthcare directive is one part of a fuller estate plan. Most New York adults also need:

A last will and testament to direct who inherits
A durable power of attorney for financial decisions
A revocable living trust for some families who want to plan around probate

Your Health Care Proxy covers the medical side. Your power of attorney covers the financial side. With your will or trust, these documents protect you during life and after death.

The Bottom Line

New York gives you a Health Care Proxy to name your medical decision-maker, written instructions to record your wishes, and MOLST for serious-illness orders when a clinician is involved. Sign your proxy while you are healthy, name an alternate, address feeding and fluids, and use two witnesses who are not your agent. Then talk with your agent and share copies, so the people who matter can act when it counts.

Official Sources

Sources

This guide is general information, not legal advice. Consult a qualified attorney about your situation. It is not legal advice.