California Estate Planning: Enforce Your DNI Wishes Now
Why your DNI wishes belong in your estate plan
A Do-Not-Intubate (DNI) instruction tells clinicians you do not want a breathing tube and mechanical ventilation. In California, the primary place to capture this is an advance health care directive (AHCD) that names an agent and states your treatment preferences, including life-sustaining measures. Integrating your DNI into your broader estate plan ensures your medical choices and fiduciary appointments work together and that the right person can advocate for you.
Key documents to make your DNI effective in California
- Advance Health Care Directive (AHCD): Lets you appoint a health care agent (surrogate) and state specific treatment decisions such as DNI, DNR, artificial nutrition/hydration, pain relief, and organ donation. See California Probate Code on individual instructions and agent authority (Probate Code, Div. 4.7, ch. 2, art. 2).
- Physician Orders for Life-Sustaining Treatment (POLST): A medical order completed with your clinician for individuals with serious illness or frailty. It can include orders limiting intubation and ventilation and is intended to be honored across care settings, including by EMS in California (see California POLST; California EMSA).
- Wallet card and copies: Keeping accessible copies and notifying your agent and primary physician increases the likelihood your wishes are located quickly in an emergency.
How California providers must honor your instructions
California law permits adults to give individual health care instructions and to appoint an agent through an AHCD (Probate Code, Div. 4.7, ch. 2, art. 2). Health care providers are generally required to comply with a valid individual instruction or an agent’s decision, subject to limited conscientious objection and transfer provisions (art. 3).
When a valid POLST is present, it functions as medical orders that clinicians and EMS use in the field and in the hospital (see California POLST; EMSA). If both a POLST and an AHCD exist, clinicians generally follow the most current and applicable document together with your known wishes and your agent’s authority. In practice, teams consult your agent and rely on what appears to be your latest, applicable instructions.
Practical steps to put your DNI into effect
- Be specific: In your AHCD, state “Do Not Intubate,” and address related interventions such as non-invasive ventilation (e.g., BiPAP), ICU admission, and resuscitation to reduce ambiguity.
- Appoint the right agent: Choose someone who understands your values and will advocate clearly with clinicians. Give them copies and talking points.
- Consider POLST when appropriate: If you have a serious illness or advanced frailty, ask your clinician whether a POLST reflecting your DNI is indicated (California POLST).
- Make it findable: Provide copies to your agent, primary care clinician, relevant specialists, and local hospital. Keep a copy near the bed or on the refrigerator for EMS, and carry a wallet card.
- Review after major changes: Revisit your documents after a new diagnosis, hospitalization, or change in prognosis, and after changes in relationships or preferences.
Execution requirements for a valid California advance directive
Your AHCD must be properly executed to be effective. California law provides that you sign the directive and either have it notarized or witnessed by two qualified adults, with limits on who may serve as witnesses. For residents of certain facilities (e.g., skilled nursing facilities), special witness requirements apply (see Probate Code, Div. 4.7, ch. 2, art. 2). Using the statutory framework helps providers rely on your directive quickly.
DNI, DNR, and ventilation: clarifying common confusion
DNI pertains to placement of a breathing tube and mechanical ventilation. DNR pertains to not performing chest compressions or defibrillation if your heart stops. You may choose DNI without choosing DNR, or vice versa, depending on your goals. Your directive should address both and clarify preferences on time-limited trials, non-invasive ventilation, and comfort-focused care.
If a provider or facility objects
A provider who declines to comply because of conscience or policy must generally inform you or your agent promptly and take reasonable steps to transfer care (Probate Code, Div. 4.7, ch. 2, art. 3). Clear documentation, a named agent, and up-to-date records make transfer smoother if needed.
Coordinate with your broader estate plan
Align your medical directives with your financial and legal appointments. Coordinate your AHCD with your durable power of attorney for finances, HIPAA releases, living trust, and beneficiary designations so your agent can access information, pay for appropriate care, and carry out your plan without delay.
Tips to make your wishes discoverable
- Tell your closest family what DNI means for you and who your agent is.
- Upload your directive to your patient portals if available.
- Ask your primary care office to flag your chart with your directive and POLST status.
- Place a copy in a visible home location and keep a spare in your car glove box.
Checklist: Make your California DNI actionable
- Complete and sign a California-compliant AHCD naming your agent.
- Discuss goals of care with your clinician; complete a POLST if appropriate.
- Give copies to your agent, primary clinician, and local hospital.
- Add a wallet card noting “DNI” and your agent’s contact information.
- Review documents after major health or life changes.
FAQ
Is a POLST required for a DNI?
No. Your AHCD can state a clear DNI. A POLST is recommended when you have serious illness or frailty because it acts as medical orders that EMS and hospitals follow (California POLST).
Which controls if I have both an AHCD and a POLST?
Clinicians generally honor the most current and applicable document together with your known wishes and your agent’s decisions.
Can I choose DNI but still want CPR?
Yes. DNI and DNR are separate choices. You can decline intubation yet allow CPR, or vice versa, depending on your goals.
Do I need a lawyer to complete an AHCD?
No, but a California estate planning attorney can help ensure proper execution, clarity, and coordination with your broader plan.
When to seek legal and medical guidance
Work with both your clinician and a California estate planning attorney. Your clinician can translate goals into clinical orders (including POLST when indicated), and your attorney can draft an AHCD that satisfies California’s execution requirements and integrates with your estate plan.
How our firm can help
We draft California-compliant advance health care directives with clear DNI language, coordinate POLST discussions with your clinicians, and ensure your estate plan supports your medical choices. We also provide guidance for agents on asserting and documenting your wishes during hospitalization.
Ready to put your wishes in writing? Contact our California estate planning team to get started.
Disclaimer (California): This blog is for general informational purposes only and is not legal or medical advice. Reading it does not create an attorney-client relationship. Laws and procedures can change and vary by circumstances; consult a qualified California attorney and your clinician for advice about your situation.