Health Care Directives and POAs for LGBTQ Pennsylvanians

If you are hospitalized and cannot speak for yourself, someone has to decide your care and someone has to be let into the room. For LGBTQ couples, that moment was historically where partners got shut out: turned away at the door, denied information, overruled by relatives. The fix is paperwork. The right directives and powers of attorney name your person, give them authority, and hold up whether or not anyone questions your relationship.

Who decides if you sign nothing

Pennsylvania does not leave the decision blank. When there is no health care agent named in a document, the law hands authority to a ranked list of people under 20 Pa.C.S. § 5461(d), the surrogate provision of Act 169 of 2006. The order runs like this: the spouse (unless a divorce action is pending) together with any adult children who are not the spouse's children; then an adult child; then a parent; then an adult brother or sister; then an adult grandchild; then a close friend or other adult who has sufficient knowledge of your preferences and values.

Read that list again and look for an unmarried partner. The partner is not a class of their own anywhere in it. A partner can only ever reach the last catch-all category, the adult who knows your wishes, and only if no spouse, adult child, parent, sibling, or adult grandchild is available to step in first. If your mother or your brother is reachable, your partner of twenty years is outranked by operation of law. That is not a comment on your relationship. It is where the statute leaves people who have not signed a document.

For a married same-sex couple the picture is better: your spouse is first in line. But "first in line under a default list" is not the same as "named in your own signed directive." A directive removes the doubt up front, and it travels with you across state lines where a hospital's read of your marriage should never be the deciding factor.

The document set that fixes it

Four documents do the work. Each one is short, and together they cover both your care and your finances.

Health care power of attorney. This names the person who makes medical decisions for you when you cannot, and it puts your partner ahead of the statutory list. It is the single most important document here. See our health care directives and living wills page for how Pennsylvania treats these.

Living will, also called a health care declaration. This states your wishes about life-sustaining treatment if you are at the end of life and cannot communicate. It guides your agent and your doctors so the hard calls are not guesswork.

HIPAA authorization. This gives your partner the legal right to see your medical records and talk to your providers. Decision authority without information access is half a plan; this closes the gap.

Financial power of attorney. This lets your partner handle money, bills, and property if you are incapacitated. Medical and financial authority are separate documents, so a complete plan includes both. See our powers of attorney page for the durability and notice rules.

Hospital visitation and records access

Two of these documents do the visitation and information work directly. The health care power of attorney identifies the person the hospital must consult about your care, which in practice is also the person staff treat as the one who belongs at your bedside. The HIPAA authorization confirms who may receive information about your condition, so your partner is not standing in a hallway being told the hospital cannot say anything.

Keep copies where they are reachable in an emergency: with your partner, in your phone, and with your primary care provider. A directive in a drawer at home does not help at 2 a.m. in an emergency room two states away.

Why married couples should sign these too

Marriage gives you a strong default, and it should. Obergefell remains the law, the federal Respect for Marriage Act requires recognition of valid marriages, and the Supreme Court declined to revisit the question in late 2025. Still, there is an active effort to tee up a future challenge, and parentage-presumption disputes are live in other states right now. None of that changes your rights today. It is a reason to hold belt-and-suspenders documents that do not depend on anyone correctly recognizing your marriage in a stressful moment.

There is a simpler reason too. You travel. Emergencies happen away from home, in front of hospital staff who have never met you. A signed health care power of attorney is the same document in Pennsylvania, Florida, or anywhere else, and it answers the "who decides" question without a debate. For married and unmarried couples alike, that durability is the point.

Getting this done in Bucks County

This is part of a complete plan. If you are not married, the stakes are higher across the board, and our page on estate planning for unmarried partners in Pennsylvania walks through what intestacy leaves a partner (nothing) and how to fix it. For the full picture, start with our pillar on LGBTQ estate planning in Pennsylvania, or see the estate planning hub.

If you want your partner to be the one who decides and the one who is let in, let us put it in writing. We are happy to sit down with you in Bucks County, answer your questions, and prepare the full set in one visit. Schedule a free consultation or send us a message to get started.

Statutory content on this page was last verified against Pennsylvania statutes (20 Pa.C.S.; 72 P.S. Art. XXI): Jun. 2026. If you are reading this significantly after that date, confirm key provisions with current statute text or contact our office.