| name | health-care-agent-letter |
| title | Instruction Letter to Health Care Agent |
| description | Drafts a non-binding instruction letter (values letter / legacy letter) from a client to their designated health care agent, translating personal values, quality-of-life thresholds, and scenario-based treatment preferences into operational bedside guidance for substituted judgment. Trigger when the user mentions values letter, legacy letter, instruction letter to healthcare proxy, substituted judgment guidance, supplementing an advance directive with personal guidance, or communicating treatment wishes to a designated agent. Also trigger for family conflict around medical decision-making authority. |
| author | CaseMark |
| author_url | https://github.com/CaseMark/skills/tree/main/skills/legal/health-care-agent-letter |
| license | Apache-2.0 |
| version | 0.1.0 |
| execution_mode | open |
| jurisdiction | us |
| practice | trusts-and-estates |
| language | en |
| tags | ["drafting","letter","transactional"] |
Instruction Letter to Health Care Agent
Non-binding, client-voiced letter that supplements formal advance directives with operational guidance a health care agent can use at the bedside. Not a legal document — the most important supplement to one. In "clear and convincing evidence" jurisdictions (e.g., New York), the letter also serves a critical evidentiary function.
ATTORNEY REVIEW REQUIRED — Draft must be reviewed by a licensed attorney before use.
Quick Start
- Run pre-draft intake (Checkpoint A)
- Frame letter and harmonize with legal documents
- Translate values into decision-making principles
- Draft scenario-based treatment guidance
- Address religious/spiritual/cultural commitments
- Establish agent authority and conflict management
- Draft closing and distribution plan
- Run post-draft alignment (Checkpoint B)
- Run quality audit
Checkpoint A: Pre-Draft Intake
Gather before drafting (apply labeled defaults if user says "use defaults" or doesn't respond):
| Topic | Gather | Default |
|---|
| Executed documents | HCPOA/proxy, living will, POLST/MOLST, HIPAA auth, organ donation. If unavailable, frame letter as "pending harmonization with signed directives" | Supplement to existing directive |
| Identity & audience | Client name; primary agent + alternates (names, relationships); share now or upon incapacity | Primary agent audience |
| Medical context | Major diagnoses, chronic conditions, hospitalizations, cognitive baseline, formative experiences (e.g., caring for parent with dementia) | — |
| Values & tipping points | What makes life meaningful; independence definitions; cognitive thresholds; longevity vs. comfort; pain/sedation/dependence tolerance; home vs. facility | Comfort-focused |
| Treatment preferences | CPR, ventilator, dialysis, feeding tubes, antibiotics, major surgery, time-limited trials, palliative sedation | Moderate detail |
| Religious/spiritual/cultural | Rituals, sacraments, clergy contacts, dietary restrictions, modesty, doctrinal positions | — |
| Family dynamics | Likely objectors, communication wishes, conflict preferences, who to inform | — |
| Tone | Intimate, direct, spiritual, humorous, formal |
