Ohio Healthcare Directive Guide

Ohio uses two separate documents for healthcare planning: a Health Care Power of Attorney (HCPOA) and a Living Will Declaration. The HCPOA names someone to make medical decisions when you cannot. The Living Will tells your doctors what you want at the end of life. You need both for full protection, and understanding how they interact is critical because Ohio has a specific rule about conflicts between the two.

This guide explains both documents, covering Ohio Revised Code (ORC) Sections 1337.11-17 and 2133.

What These Documents Do

Health Care Power of Attorney (ORC 1337.11-17)

This document names an agent (sometimes called an "attorney-in-fact") to make healthcare decisions when you cannot make them yourself. Your agent's authority begins when your attending physician determines that you lack the capacity to make informed healthcare decisions.

Your agent can:

Consent to or refuse medical treatments
Choose healthcare providers and facilities
Access your medical records (with HIPAA options, see below)
Make decisions about organ donation
Authorize an autopsy
Make decisions about body disposition after death

Your agent cannot:

Authorize assisted suicide

Living Will Declaration (ORC 2133)

Ohio calls its living will a "Living Will Declaration." It gives direct instructions to your doctors about life-sustaining treatment. It applies in two situations:

Terminal condition - an irreversible, incurable, and untreatable condition from which there can be no recovery
Permanently unconscious state - a state of permanent unconsciousness with no awareness of your environment

Your Living Will Declaration can address:

Withholding or withdrawing life-sustaining treatment
Nutrition and hydration decisions
Do-not-resuscitate (DNR) preferences

Two physicians must agree on your condition before your living will takes effect.

When the HCPOA and Living Will Conflict

Here is a rule that makes Ohio different from many states: if your HCPOA and Living Will Declaration conflict, the Living Will Declaration takes priority. This means your written end-of-life instructions override any decisions your agent might try to make that go against those instructions.

This is why your Living Will Declaration should be specific and detailed. Your agent fills the gaps, but your living will has the final word on end-of-life care.

Who Can Create One

To create either document in Ohio, you must:

Be a competent adult (18 or older)
Understand the nature and consequences of the document
Act voluntarily

You do not need to be an Ohio resident to create Ohio-compliant documents. If you receive medical care in Ohio, having Ohio-specific documents is a good idea.

How to Create a Health Care Power of Attorney

Step 1: Choose your agent. Ohio restricts who can serve as your healthcare agent. The following people cannot serve (unless they are related to you):

Your attending physician
The administrator of a nursing facility where you receive care

Pick someone who knows your values and can handle difficult decisions under pressure.

Step 2: Define the scope of authority. You can give your agent broad authority or limit it. Think about whether you want to restrict decisions about specific treatments, experimental procedures, or other areas.

Step 3: Choose your HIPAA access level. Since the 2014 amendment to Ohio's HCPOA statute, the document includes three HIPAA options:

HIPAA Option	What It Means
Full access	Your agent can access all your medical records
Limited access	Your agent can access only records related to your current condition
No access	Your agent cannot access your medical records

Most people choose full access. Limited access or no access can create practical problems when your agent needs information to make decisions.

Step 4: Sign the document. You need either:

2 witnesses, OR
Notarization

Either option is sufficient. You do not need both.

Signing Requirements for HCPOA

Requirement	Details
Principal's signature	Required
Option A: Witnesses	2 required
Option B: Notarization	Sufficient on its own
Attorney	Not required

Who Cannot Be a Witness (HCPOA)

The following people cannot serve as a witness for your HCPOA:

Your designated attorney in fact or any alternate attorney in fact
Any person related to you by blood, marriage, or adoption
Your attending physician
The administrator of a nursing facility where you receive care

How to Create a Living Will Declaration

Ohio's Living Will Declaration has the same signing options as the HCPOA.

Step 1: Decide your treatment preferences. Think carefully about what you want if you are diagnosed with a terminal condition or become permanently unconscious. Address life support, mechanical ventilation, CPR, tube feeding, dialysis, and hydration.

Step 2: Be specific about nutrition and hydration. Ohio allows you to address the withholding or withdrawal of nutrition and hydration in your Living Will Declaration. If you have strong feelings about this, state them clearly. This is one of the most common areas of family disagreement.

Step 3: Consider a DNR provision. You can include do-not-resuscitate instructions in your Living Will Declaration. Specify whether you want CPR attempted if your heart stops.

Step 4: Sign the document. Your Living Will Declaration requires either:

2 witnesses, OR
Notarization

Either option is sufficient. You do not need both (ORC 2133.02(B)).

Signing Requirements for Living Will Declaration

Requirement	Details
Principal's signature	Required
Option A: Witnesses	2 required
Option B: Notarization	Sufficient on its own
Attorney	Not required

Who Cannot Be a Witness (Living Will)

Your witnesses should not be:

Any person related to you by blood, marriage, or adoption
Your attending physician
The administrator of a nursing facility where you receive care

When These Documents Take Effect

Health Care Power of Attorney: Your agent's authority begins when your attending physician determines that you lack the capacity to make your own healthcare decisions. If you regain capacity, your agent's authority pauses. It reactivates if you lose capacity again.

Living Will Declaration: This takes effect when two physicians agree that you have a terminal condition or are in a permanently unconscious state. Until both physicians confirm your condition, the living will has no effect on your care.

HIPAA and Medical Records Access

Ohio's 2014 amendment to the HCPOA statute was a significant update. Before 2014, agents often needed a separate HIPAA authorization to access medical records. The amendment integrated HIPAA directly into the HCPOA with three access levels (full, limited, or none).

If your HCPOA was created before 2014, it may not include HIPAA language. Consider updating your document to take advantage of the integrated HIPAA options. An older HCPOA is still valid, but adding HIPAA authorization prevents delays and disputes with healthcare providers.

For your Living Will Declaration, HIPAA is less of a concern because the living will gives direct instructions to physicians, not to an agent. The doctors implement your wishes directly.

Special Rules to Know

Living will takes precedence. If your agent tries to make a decision that conflicts with your Living Will Declaration, the living will wins. This is unique to Ohio and makes your living will especially important to get right.

Two-physician requirement. Your Living Will Declaration does not take effect until two physicians agree on your condition. This adds a layer of protection against premature activation.

Agent authority is broad. Your HCPOA agent can make decisions about organ donation, autopsy, and body disposition. If you have preferences about any of these, state them in your HCPOA or discuss them with your agent.

Attending physician restriction. Your attending physician cannot serve as your healthcare agent unless they are related to you. The same applies to administrators of nursing facilities where you receive care.

No expiration. Neither document expires in Ohio. They remain valid until you revoke them.

Out-of-state recognition. Ohio generally honors healthcare directives from other states if they were valid where executed. If you live in Ohio and spend time in another state, consider having documents for each state.

How to Update or Revoke

You can change or cancel either document at any time if you have capacity.

To revoke a Health Care Power of Attorney:

Sign a new HCPOA (revokes the prior one to the extent of any conflict)
Execute a written revocation
Verbally tell your attending physician (who must note it in your record)
Destroy the document

To revoke a Living Will Declaration:

Sign a new Living Will Declaration
Execute a written revocation
Verbally tell your attending physician
Destroy the document

Verbal revocations take effect immediately. Make sure your physician documents the revocation in your medical record.

Common Mistakes

Using the wrong signing rules. Both the HCPOA (ORC 1337.12) and the Living Will Declaration (ORC 2133.02(B)) require either 2 witnesses or notarization. Make sure you complete at least one of these options properly. Missing both can invalidate your document.

Ignoring the HIPAA options. If you do not select a HIPAA access level in your HCPOA, your agent may face obstacles when trying to get medical information. Choose full access unless you have a specific reason not to.

Not understanding the conflict rule. Your living will overrides your agent's decisions. If your living will says to withdraw life support and your agent wants to continue treatment, the living will controls. Make sure your living will reflects your actual wishes, because it has the final say.

Having a pre-2014 HCPOA. If your HCPOA was created before the 2014 amendment, it probably does not include HIPAA authorization. Consider creating a new one with the updated language.

Being vague about nutrition and hydration. This is one of the most emotionally charged decisions in end-of-life care. If your Living Will Declaration does not specifically address it, your family and doctors may disagree about what you would have wanted. Be clear.

Not telling anyone. File your documents with your doctors. Give copies to your agent, your alternate agent, and close family members. Keep the originals in a safe, accessible location.

Only having one document. The HCPOA covers incapacity from any cause. The Living Will Declaration covers end-of-life situations specifically. If you only have one, gaps exist. A car accident that leaves you unconscious but not terminal may not trigger your Living Will, making the HCPOA essential. A terminal diagnosis is best handled by the Living Will's direct instructions to your physicians.

How This Fits Into Your Estate Plan

Your healthcare directives are part of a larger Ohio estate plan. Most Ohioans also need:

A last will and testament for asset distribution
A durable power of attorney for financial decisions
An understanding of Ohio probate procedures

The HCPOA and Living Will Declaration handle medical decisions. A financial power of attorney handles money and property. Your will handles what happens to your assets after death. Together, these documents provide complete coverage for incapacity and death.

The Bottom Line

Ohio gives you two healthcare planning tools: a Health Care Power of Attorney (ORC 1337.11-17) and a Living Will Declaration (ORC 2133). You need both. Pay attention to the signing requirements: both documents require either witnesses or notarization. Choose your HIPAA access level in the HCPOA. And remember that your Living Will Declaration has the final word if it conflicts with your agent's decisions.

Create these documents now. Talk to your agent about your values and preferences. Give copies to your physicians and family. And if your HCPOA is from before 2014, update it to include the HIPAA integration.