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Health Line
03-07-2025
- Health
- Health Line
Your Guide to Advance Directives
Advance directives are legal documents that outline your preferences regarding major medical decisions. The two main types are a living will and a durable power of attorney. An advance directive is one potential part of advance care planning. This involves having conversations with your loved ones or trusted people about your medical care if you become seriously ill or unable to communicate your wishes. What is an advance directive? An advance directive is a legal document that outlines your wishes regarding future major medical decisions. These documents typically go into effect when you cannot communicate your wishes. Typically, an advance directive addresses decisions related to end-of-life care. However, it can address any aspect of care. For example, many people use advance directives to focus on mental health treatments. It is important to note that in the United States, advance directive laws may differ by state, and each state may only allow certain types. Healthcare proxy You can use an advance directive to name a healthcare proxy. This is a person who acts as a surrogate, agent, or representative for you if you cannot make decisions for yourself. Your healthcare proxy will work closely with your healthcare team to ensure they follow your treatment and care preferences. Naming a healthcare proxy can be especially useful in unexpected situations, such as if you have a stroke or a car accident. The requirements for healthcare proxies vary by state. In most states, the individual must be over 18 years old. Many people choose a family member. Other people may choose a lawyer, a trusted friend, or a neighbor. While each state sets its own requirements, the American Bar Association generally recommends not choosing any of the following: your healthcare professional, their spouse, their employee, or the spouse of an employee the owner or operator of your residential or healthcare facility someone working for a government agency who is financially responsible for your care any professional who is responsible for evaluating your ability to make decisions your court-appointed conservator or guardian someone who already serves has a healthcare proxy for 10 or more people Types of advance directives The two main types of advance directives are the living will and the durable power of attorney. Living will A living will is a legal document that states certain future healthcare decisions. It only becomes effective if you cannot make choices and decisions on your own. It is called a 'living' will because it is in effect while you are still alive. It often involves decisions regarding end-of-life care. A living will can describe under what circumstances attempts to prolong life should be used or stopped. This applies to treatments like dialysis, feeding tubes, and life support. Healthcare professionals can only use your living will to guide medical decisions after two doctors confirm you cannot make decisions for yourself. You can end or take back your living will at any time. However, a living will must comply with state law to be legally valid, which may vary. »Learn more: Living wills. Durable power of attorney A durable power of attorney is a legal document that allows you to appoint a proxy to make medical, legal, or financial decisions on your behalf. A durable power of attorney typically becomes effective when you can no longer make independent decisions. It is important to note that while some states recognize a durable power of attorney as active as soon as it is signed, your proxy cannot use it to make medical decisions until your doctor certifies that you cannot make them yourself. »Learn more: Healthcare power of attorney. Other types There are two other types of advance directives: Do Not Resuscitate Order (DNR): This is a written document that is typically signed by your healthcare professional that states whether you want them to resuscitate you if you stop breathing or your heart stops. In most states, this is the only advance directive order Emergency Medical Services (EMS) have to consider. A DNR allows you to choose which procedures to accept or decline. Physician's Orders for Life-Sustaining Treatment (POLST): A POLST is a newer type of advance directive. It is an agreement between a doctor and you regarding a specific condition. The POLST documents the condition, summarizes your wishes regarding treatment, and records your wishes as medical orders. Who needs an advance directive? Anyone can consider setting up an advance directive. People of any age can experience a medical crisis that could leave them unable to communicate their medical wishes. However, advance directives may be more important for older people to consider. Individuals with a recent diagnosis of dementia may find it particularly important to put this document in place to protect their future needs and wishes. It allows them to participate directly in the decision making about their care. What if you don't have an advance directive? If you don't have an advance directive and you become unable to make your own decisions, the laws in the state where you live determine who will make medical decisions on your behalf. Generally, this may be your spouse, adult children, or your parents if they are available. If you are unmarried and have not officially named your partner as your proxy, they may be unable to participate in the decision making. If you do not have any family members, the state may appoint a close friend or a doctor to act in your best interest. To find the laws in your state, contact your state legal aid office or state bar association. Tips for getting started To get started with creating an advance directive, consider the following: Reflect: Take the time to consider your values and wishes. This can help you decide what matters most to you regarding end-of-life care and guide you in your decisions. Talk: Speak with your primary care doctor about advance directives. This can help you learn more about your current health and what decisions may come up in the future. Choose: Pick someone you trust as your healthcare proxy. Once you have decided, speak with this person about your values and wishes. Complete: Fill out any necessary forms to create the type of advance directive you desire. Share: Show your completed advance directives to your healthcare proxy, loved one, and doctors. Some states may even have a registry where you can store your advance directive for easy access by healthcare professionals or your proxy. Be sure to continue discussing your wishes and update your advance directive each year or after siignificant life changes. Did you know? Medicare covers Advance care planning as part of your annual wellness visit. Medicare may also cover this service as part of your medical treatment. If you receive this service from your doctor during your annual wellness visit, there is no cost to you. If you receive it during any other type of appointment or treatment, the Medicare Part B deductible and 20% coinsurance apply.
New York Times
30-06-2025
- Business
- New York Times
Senate's New A.I. Moratorium Proposal Draws Fresh Criticism
Two senior senators have reached a compromise on an amendment in the Republican economic policy bill that would block state laws on artificial intelligence. Senators Marsha Blackburn, Republican of Tennessee, and Ted Cruz, Republican of Texas, agreed late Sunday to decrease a proposed moratorium on state laws regulating the technology to five years from 10. But Democratic lawmakers and consumer protection groups on Monday criticized new language in the amendment that would create a higher standard for the enforcement of existing tech-related state laws, including those for online child safety and consumer protections. Any current laws related to A.I. cannot pose an 'undue or disproportionate burden' to A.I. companies, according to the amendment. That broad language could allow tech companies — almost all of which are developing A.I. — to challenge existing state laws and regulations that apply to the use of a wide-range of automated technologies, legal experts said. Democrats and consumer protection groups warned that the new language could strip consumers of important protections provided by state laws aimed at warding off robocalls, regulating social media algorithms that steer users toward harmful content and prohibiting child sexual abuse imagery. Want all of The Times? Subscribe.
Forbes
13-06-2025
- Business
- Forbes
Congressional Budget Bill Could Override State AI Laws
Employers increasingly face a patchwork of state laws governing the use of artificial intelligence (AI) and automated decision systems (ADS) in hiring, promotion, and workforce management. But that may change dramatically. On May 22, the U.S. House of Representatives passed the 'One Big Beautiful Bill Act' (OBBBA), a sprawling budget reconciliation package that includes a controversial provision: a 10-year federal moratorium on state and local regulation of AI. Buried in Section 43201, the measure would prohibit any state or municipality from enforcing laws that regulate AI models, AI systems, or automated decision systems for a decade after the bill's enactment. The scope is broad. If enacted, the provision would preempt a wide range of existing state and local laws and halt momentum behind dozens of AI-related bills pending across legislatures nationwide. Section 43201 explicitly bars state and local governments from enforcing laws that limit, restrict, or otherwise regulate AI systems, models, or automated decision systems. The proposed preemption period lasts ten years. The language is sweeping. If enacted, it would suspend enforcement of laws specifically targeting AI, including those governing how employers deploy algorithmic tools in employment decisions. The bill defines 'artificial intelligence systems' as machine-based systems that, for a set of human-defined objectives, make predictions, recommendations, or decisions that influence real or virtual environments. 'Automated decision systems' are defined even more broadly. These include any computational process using machine learning, statistical modeling, or data analytics that outputs a classification, score, or recommendation intended to materially influence or replace human decision-making. Taken together, these definitions likely cover tools that employers use every day, from resume screening software and video interview scoring platforms to employee monitoring systems powered by machine learning. If passed, the moratorium would put existing state and municipal AI regulations on hold, including: The proposal would also preempt emerging AI legislation, including numerous AI-related bills introduced across statehouses in 2025. While the moratorium is expansive, Section 43201 does include limited exceptions. A state or local law would not be preempted if it: These exceptions are narrow. While they may preserve state laws that apply broadly to both AI and non-AI tools performing similar functions, most current AI employment laws are unlikely to qualify. These laws often impose requirements, such as bias audits, transparency disclosures, or data handling rules, specifically tailored to AI systems, making them vulnerable to preemption under the bill. In practice, unless a state law imposes requirements that apply equally to both AI and traditional systems performing similar tasks, it is likely to be preempted. Section 43201 was advanced through the House Energy and Commerce Committee in mid-May and included in the broader budget reconciliation bill that passed the House by a 215–214 vote. Because the bill is proceeding under budget reconciliation, it is immune to filibuster in the Senate and could pass with a simple majority. Still, the provision faces significant obstacles. Critics argue that the moratorium is regulatory in nature and may not meet the budgetary requirements of the reconciliation process under the Byrd Rule. The Byrd Rule limits reconciliation bills to provisions that directly affect federal spending or revenue, and allows regulatory provisions, like this moratorium, to be struck before a Senate vote. If ruled out of order, the Senate Parliamentarian could remove the AI moratorium provision altogether. Additionally, a bipartisan coalition of 40 state attorneys general has voiced strong opposition to the measure, citing concerns over states' constitutional authority to protect consumers and workers. Legal scholars have raised potential challenges under the Tenth Amendment, particularly given the moratorium's interference with state police powers related to public health, safety, and civil rights. Even if enacted, the moratorium is likely to face immediate litigation. For employers who use AI in employment decisions, this bill creates both uncertainty and opportunity. Until the Senate acts, state laws remain in effect. Employers should continue to assess compliance obligations under local statutes like Local Law 144 in New York City and forthcoming measures in Illinois and Colorado. At the same time, organizations should begin scenario planning for a world in which those state-level obligations are preempted. That may include: Even if a moratorium is enacted, employers remain responsible for the outcomes of their employment decisions. AI does not shield organizations from liability. Human oversight, fairness, and transparency should remain cornerstones of responsible hiring. Section 43201 represents one of the most aggressive attempts yet to consolidate AI regulation at the federal level. For employers navigating a fractured and fast-evolving regulatory landscape, the measure promises temporary clarity, but at the cost of state-level experimentation and innovation. Whether the moratorium survives reconciliation and legal challenge remains to be seen. In the meantime, employers should not assume that compliance obligations will disappear. Instead, they should continue investing in practices that promote transparency, accountability, and fairness in AI-driven employment decisions, and prepare for the possibility of a federally preempted landscape.
