healthcare-agent-instruction-letter

name	healthcare-agent-instruction-letter
title	Healthcare Agent Instruction Letter
description	Drafts a non-binding healthcare values/instruction letter for a designated health care agent to guide substituted-judgment decisions during incapacity. Use when a client needs a bedside document that harmonizes with a health care power of attorney, healthcare proxy, or advance directive and captures quality-of-life thresholds, treatment preferences, and conflict guidance. Trigger on requests for "instruction letter," "health care agent letter," "values letter," "legacy letter," "healthcare proxy," or "DPOA health care."
author	CaseMark
author_url	https://github.com/CaseMark/skills/tree/main/skills/legal/healthcare-agent-instruction-letter
license	Apache-2.0
version	0.1.0
execution_mode	open
jurisdiction	us
practice	trusts-and-estates
language	en
tags	["drafting","letter","regulatory","transactional"]

Healthcare Agent Instruction Letter

Drafts a scenario-based, non-binding values letter in the client's voice to empower the health care agent and reduce ambiguity at the bedside. Output supplements—never replaces—operative legal directives.

Quick Start

1. Confirm client identity, preferred name, and jurisdiction.
2. Collect executed documents (name/date/type): health care POA or proxy, advance directive, POLST/MOLST, HIPAA release.
3. Identify primary agent and alternates (full names, roles, contact preferences).
4. Capture core values: quality-of-life thresholds, cognition-loss tolerance, dependence, pain, institutional care.
5. Capture clinical preferences: CPR, ventilation, artificial nutrition/hydration, antibiotics, surgery, time-limited trials, hospice, comfort care.
6. Capture spiritual/cultural commitments affecting care decisions.
7. Identify conflict vectors and family communication plan.
8. Capture tone preference, distribution timing, and document-storage locations.
9. Never invent names, dates, diagnoses, or beliefs—ask for missing facts and use [placeholder].

Core Workflow

Phase	Action	Output
1	Validate non-binding status	Opening disclaimer: guidance only, not a substitute for operative directives
2	Harmonize documents	List governing document titles/dates; note instruction hierarchy
3	Elicit decision framework	Big-Three thresholds: cognition, independence, suffering
4	Draft scenario logic	Treatment sections with conditional "if/when…then…" examples
5	Add faith/culture mechanics	Practical care requests tied to beliefs, without legal overstatement
6	Address conflict protocol	Disagreement scripts, consult triggers, clinician communication
7	Add logistics	Distribution plan: who receives, when, storage locations
8	Run quality controls	Mismatch flags, ambiguity reduction, attorney-review gate

Writing Constraints

• Client voice, plain language, short headings, 1–3 pages.
• Conditional framing throughout: "if/when…then…" with scenario examples.
• No medical orders or statutory language belonging in POLST/MOLST/clinic forms.