Are "Advance Directive Registries" a Practical Solution?

John Robinson |

The Most Important Factors in Estate Planning

I often preach that the mere act of drafting one's estate planning documents does not complete the estate planning process. In most cases, these documents may only be effective if the people named to serve on your behalf are aware of their roles and have copies/access to these documents. Proper implementation and ongoing review/updating are critical.

Of all of the major estate planning documents, the Advance Health Care Directive (AHCD) (a.k.a., health care proxy, medical power of attorney, etc.) is arguably the most important - or at least the one that may be needed most urgently. However, as a practical matter, in a medical emergency, the person you have named to make health care decisions on your behalf may not have ready access to your AHCD, or, worse, may have lost the documents, forgotten that he/she has a copy and/or forgotten that you have chosen them.

To help address this problem, many hospitals maintain copies of these documents for their patients. Still, this solution is only effective if you are under the care at institutions that have copies of your AHCDs, and the institutions have done a good job of maintaining their registries. As a broader solution, a handful of states have established Advance Directive Registries for their residents, so that medical professionals may access this document if needed, regardless of the facility to which you have been taken. Such registries also often provide a wallet card to alert EMTs of the document’s existence.

In Hawaii, this information appears on one’s driver’s license. The registry system is an interesting idea, but is not without its flaws too. To borrow a quote from, “Practical experience has shown that doctors and hospitals have been slow to adopt the registry system; many simply do not check them when a patient is admitted .”

Similarly, a number of private registry services have also sprung up in recent years. For an annual fee, these registries promise to mail registrants updates at least once per year to make sure the agent’s information on the AHCD is still current. However, if the person(s) you have named as your agent(s) in your AHCD are unaware of the registry’s existence (or simply doesn’t remember), its effectiveness is again limited.

For my part, we encourage all Financial Planning Hawaii Clients to store copies of their critical estate planning documents in eMoney and also to provide copies to all people named to serve in your documents. We also encourage all clients to provide us with the contact information for all people named to act on their behalf and to make sure that these people also are aware of my role and have Financial Planning Hawaii’s contact information.

For more on the subject of Advance Directive Registries, see the following article links:

Living Will or Advance Directive Registries: Should You Use Them? (

Advance Directive Registries: A Policy Opportunity (Center for Healthcare Research and Transformation)