Alaska End of Life Planning: A Step-by-Step Checklist for Families

End-of-life planning in Alaska has a logistics problem no other state shares. When the nearest hospital may be a bush plane flight away and your medical records sit in a tribal EHR system your family in the Lower 48 can't access, getting the documents right is only half the job. Getting them to the right people in the right places is the other half.

Here's a practical checklist that covers both the legal documents and the distribution logistics unique to Alaska.

Step 1: Complete the Advance Health Care Directive

Alaska's five-part statutory form under AS 13.52 handles healthcare agent designation, living will instructions, organ donation, mental health treatment preferences, and primary physician designation. Complete as many sections as apply to your situation — each is independently enforceable.

Execute it using either two qualified witnesses or a notary. For rural families, the two-witness method is often more practical. If you need body disposition instructions, those require notarization under AS 13.75.010.

Step 2: Add a HIPAA Authorization

Your advance directive gives your healthcare agent access to medical records — but many Alaska institutions require a separate HIPAA release form to actually hand over the information. The Alaska Division of Retirement and Benefits, AlaskaCare plans, and some hospital systems won't accept a power of attorney alone.

Complete a standalone HIPAA authorization (such as DRB Form BEN043) and file it alongside your directive. This closes the "Spouse Trap" — the gap where hospitals refuse to share information with a spouse who lacks explicit written authorization.

Step 3: Discuss a POLST with Your Provider

If you have a serious, advanced, or terminal illness, ask your physician, PA, or APRN about completing a POLST. Since November 2022, PAs and APRNs have full signing authority — critical in rural communities where they're often the only available clinicians.

The POLST converts your advance directive preferences into active medical orders that EMS responders must follow. Your advance directive documents what you want; the POLST tells first responders exactly what to do.

Step 4: Distribute Copies Strategically

This is where Alaska planning differs most from the Lower 48. A directive locked in a filing cabinet in Fairbanks is useless during a medevac from Bethel to Anchorage. Your distribution plan should cover:

• Tribal EHR system: If you receive care through a tribal health organization, have your directive scanned into the dedicated advance directive folder on your EHR summary page. Southcentral Foundation, ANTHC, and other regional networks can retrieve it system-wide — so the receiving hospital sees your preferences before your transport lands.
• Primary care provider and specialists: File copies with every provider you see regularly.
• Local dispatch or EMS: For DNR/POLST orders, fax a copy with a HIPAA-compliant coversheet to your local dispatch center.
• Healthcare agent: Your agent needs their own copy, plus digital access if possible.
• Family members: Especially adult children in the Lower 48 who may need to coordinate with Alaska providers during an emergency.

Step 5: Plan for Out-of-State Portability

Under AS 13.52.010(k), Alaska recognizes advance directives executed in other states. If you split time between Alaska and the Lower 48 as a seasonal resident, keep copies registered with providers in both locations.

Alaska's stricter witness requirements mean your properly executed Alaska directive is generally accepted elsewhere. But carry a copy when you travel — don't assume the receiving state's hospital will have electronic access to Alaska records.

How to Revoke or Update Your Directive

You can revoke your advance directive at any time while you're competent, using any method that communicates your intent — written, oral, or by destroying the document. A new directive automatically supersedes older versions, but explicitly revoking the old one prevents confusion if multiple copies exist.

One exception: the mental health treatment declaration (Part IV) cannot be revoked once you've been determined to lack competence by the appropriate clinical or judicial panel under AS 13.52.

Review your directive whenever your health status changes, after a major medical event, or when family circumstances shift (divorce, death of your agent, move to a new state).

The Alaska Advance Directive & Living Will Kit includes the complete five-part directive, HIPAA authorization templates, a rural distribution checklist, and step-by-step instructions for every execution method available under Alaska law.

See more Alaska guides →