Episode 92: Why Turning 18 Changes Everything in a Medical Crisis
Episode 92
Host: Jill Mastroianni
Why Turning 18 Changes Everything in a Medical Crisis
Your child turns 18, but practically, not much may change. They may still live at home, be on your health insurance, and call you first when something goes wrong. Legally, though, they’re an adult—and that can make a big difference in a medical crisis.
In this episode, Jill explains three healthcare documents every parent should understand before their child turns 18: a HIPAA authorization, a healthcare power of attorney, and a healthcare advance directive. Each answers a different question about information, authority, and wishes, and each gives your adult child an opportunity to decide whom they trust to step in when they need help.
What You’ll Learn in this Episode
What really changes when your child turns 18. Being Mom or Dad no longer necessarily means you’re entitled to healthcare information or automatically have authority to make medical decisions.
Why a HIPAA authorization matters. Once your child is an adult, their medical information belongs to them, even if they’re still on your health insurance and you’re paying the bills. A HIPAA authorization lets them decide who can receive that information.
What a healthcare power of attorney actually does. Access to information and authority to make decisions are two different things. A healthcare POA lets your adult child choose who can make healthcare decisions if they’re unable to make those decisions themselves.
Why naming an agent isn’t enough. Your child can give you authority to make a decision but would you know what they wanted you to decide?
How a healthcare advance directive helps. An advance directive allows your child to document wishes involving serious illness and end-of-life care, including preferences about quality of life and treatments such as CPR, life support, and tube feeding.
The conversation to have with your 18-year-old. Instead of saying, “Sign these so I can still help you,” start with whom they trust. And consider going first by sharing the decisions you’ve made in your own healthcare documents.
What to consider when your child goes to college out of state. State laws vary, so consider whether completing forms for the state where your child attends school could make things easier for healthcare providers in an emergency.
What happens if there’s no healthcare power of attorney. Some states have backup rules. In Tennessee, for example, a healthcare provider may have to identify a surrogate—and potentially sort through competing family relationships and opinions in the process.
Why this is really about autonomy, not parental control. Turning 18 gives your child an opportunity to decide who receives their healthcare information, who speaks for them, and what that person should know about their wishes.
Resources and Links
Watch this episode on YouTube: https://youtu.be/YEW3jlgLoW0
Episode 22: What Every Parent Needs to Know When Their Child Turns 18: https://www.deathreadiness.com/podcast/episode-22-what-every-parent-needs-to-know-when-their-child-turns-18
Episode 23: What Happens When a Pregnant Woman is Declared Brain Dead?: https://www.deathreadiness.com/podcast/episode-23-what-happens-when-a-pregnant-woman-is-declared-brain-dead
Tennessee advance directive: https://www.tn.gov/content/dam/tn/hfc/documents/Advance_Directive_for_Health_Care.pdf
State-specific healthcare forms: https://www.caringinfo.org/planning/advance-directives/by-state/
Connect with Jill:
Website: DeathReadiness.com
Email: jill@deathreadiness.com
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Your child turns 18, and suddenly “I’m her mom” doesn’t carry the same legal weight it did the day before. If your child ends up in the hospital, will doctors talk to you? Can you make decisions if your child can’t, and would you know what they’d want? Today, I explain the three documents every parent should understand before their child turns 18: a HIPAA authorization, a healthcare power of attorney, and a healthcare advance directive.
Welcome to The Death Readiness Podcast. This is not your dad’s estate planning podcast. I’m Jill Mastroianni — estate planning attorney, death readiness guide, and your translator for wills, trusts, probate, and the conversations most families avoid. If you’ve been wondering things like, ‘Can a trust protect what I leave to my children?’ ‘What happens if I give someone power of attorney over me?’ and ‘How can I help my parents while respecting their independence?’ You’re in the right place.
I was 18 when I left Sayville, Long Island, to attend Stanford University in Palo Alto, California. I thought I was so grown up. And, technically, I was. I had turned 18 the previous December. I was a legal adult.
So off I went, unsuccessfully holding back tears as I flew from New York to California to start preseason training. I was also a planner. I was packed for college about two months before I actually had to leave.
But there was one thing my parents and I hadn’t planned for. What would happen if something happened to me? I didn't know that turning 18 had changed my parents' legal relationship to me. If I ended up in the hospital, they no longer automatically had the same access to my healthcare information or the same ability to step in and make decisions that they'd had when I was a minor.
And that wasn't some completely theoretical possibility. Not long after I got to Stanford, some teammates and I drove off campus for a run. We got a little lost, and the teammate driving made a U-turn on a road with poor visibility.
As we turned, a motorcycle came barreling toward my side of the car. To this day, I don't know how we avoided a collision. But we did. I was lucky. We made it home. I went on with my life. And my mom never had to find out what would have happened if her 18-year-old daughter had been seriously injured almost 3,000 miles away.
But other families aren't that lucky. And it doesn't have to be a car accident. It could be a mental health crisis. Alcohol poisoning. A fraternity pledge gone terribly wrong. It could be something completely ordinary that suddenly becomes a medical emergency.
My daughter is 15 now. And when she turns 18, whether she's heading off to college, still living at home, or pursuing some dream on the other side of the country, we're going to have a conversation. And it’s not because I want to keep making decisions for her. It’s actually, just the opposite. At 18, those decisions become hers.
Who does she want her doctors to be able to talk to? Who does she trust to make healthcare decisions for her if she can't? And what would she want that person to know about her medical wishes?
Today, I'm going to walk you through three healthcare documents and explain the very different job each one does. And while I'm framing this around that legal transition at 18, this isn't just a conversation for parents sending kids off to college. For a lot of us, Mom or Dad remains the person we'd call in a crisis long after we become legal adults.
When your child turns 18, something legally significant happens. They may have the same home life and routines. They may still call you first when something goes wrong. But legally, they're an adult. And one place where that distinction can suddenly matter a lot is healthcare. Being Mom or Dad no longer necessarily means you're entitled to information about their medical care. It doesn't necessarily mean you're the person with authority to make healthcare decisions if they can't make those decisions themselves.
And even if you are the person making those decisions, there's another question entirely: Would you know what your child wanted you to do?
Those are three different issues. Information. Authority. And Wishes. And that's the framework I want you to remember throughout this episode. Because there are three documents we're going to talk about, and each one addresses a different piece of the puzzle.
First, a HIPAA authorization is about information: Who is authorized to receive information about your healthcare? Second, a healthcare power of attorney is about authority: Whom do you choose to make healthcare decisions for you if you can't make them yourself? And third, an advance directive, is about wishes: What would you actually want that person to decide? Information. Authority. And Wishes.
So let's start with the first question: Whom do you trust with your information?
Let's imagine your daughter just turned 18 and has started college. And a few weeks later, your phone rings. She's at the emergency room. Maybe she fell down a flight of stairs, had a bad reaction to a medication, or was in a car accident. Or maybe something happened and she's perfectly capable of talking to you but she's overwhelmed, scared, and wants you involved. So you call the hospital.
And you say, "Hi. I'm her mom." For the first 17 years and 364 days of her life, that sentence carried a lot of weight. But now, she's an adult. And that's where the first document comes in: The HIPAA Authorization
HIPAA is the federal law most of us associate with medical privacy. Your adult child's medical information belongs to your adult child, not to you, even if she's on your health insurance, you’re paying the bill and she still lives in your house. Because she's an adult.
A HIPAA authorization allows her to say, "These are the people I authorize my healthcare providers to share my protected health information with."
Maybe that's you, her other parent, both of you. Or maybe it’s a sibling or a close friend. One thing that’s really important for parents to recognize here is that your child, your adult child, gets to choose.
Your daughter gets to decide who has access to information about her. That person might be you. It might not. For me, it was my dad. Until I got married at 35, my dad was the person I had authorized to receive my healthcare information.
Now let's change our hypothetical. Your daughter isn't just scared and asking for your help. She's unconscious. And someone needs to make a healthcare decision for her. Access to information isn't enough anymore.
We've moved from our first word—information—to our second: Authority. Who has the authority to make a healthcare decision when your daughter can't make that decision herself? That's where the healthcare power of attorney comes in.
A healthcare power of attorney allows your adult child to choose a person to make healthcare decisions for them if they're unable to make those decisions themselves.
The HIPAA authorization answers: Who can receive information about me? The healthcare power of attorney answers: Who can make decisions for me? Information and authority.
But now let's make our hypothetical harder. Your daughter is still unable to communicate. You've been named as her healthcare agent, so you're the person with authority to make healthcare decisions for her.
And her doctors come to you with a much harder question. They want to know what your daughter would want. Maybe they're asking about a ventilator. Maybe it's artificial nutrition or hydration. Maybe they're telling you that treatment can keep her alive, but they're asking whether continuing that treatment is what she would want under these circumstances.
You have the authority to answer. But do you know the answer? That's the problem document number three is intended to address: Wishes. An advance directive gives your child an opportunity to put their own wishes about healthcare in writing, particularly when it comes to serious illness and end-of-life care.
And I know this is the part of the conversation no parent wants to have. We're talking about your 18-year-old. The kid who was sitting at your kitchen table doing high school homework a few months ago. No one wants to sit that kid down and start talking about ventilators and feeding tubes. But if I were ever put in the position of making those decisions for my child, I would rather know what she wanted than have to guess.
In Episode 22, I told the stories of Nancy Cruzan and Terri Schiavo, two young women whose families faced extraordinarily difficult questions about life-sustaining treatment without the benefit of written healthcare advance directives. I'll link to that episode in the show notes if you want to hear their stories.
I'm not going to retell those stories today. Instead, I want you to imagine something much closer to home. Your child has named you as their healthcare agent. The doctors are looking at you. You love this person more than just about anything in the world. And now you're being asked: "What would she want?"
Would you know? That's why the conversation matters. And that's why the advance directive matters. I practice in Tennessee, and Tennessee provides an advance directive form that you can download for free. I'll link to it in the show notes, along with resources for other states.
The Tennessee form doesn't just ask one broad question like, "Do you want life support?" It asks you to think about two different things. First: What does an acceptable quality of life mean to you?
For example, the form allows you to indicate whether there are circumstances that would make your quality of life unacceptable to you, such as being permanently unconscious, suffering permanent confusion so that you can't recognize loved ones, or being unable to communicate with others.
Then it asks about treatment. If you're in one of the circumstances you've identified, what medical treatment would you want, or not want? That can include things like CPR, life support and tube feeding.
So now we have all three pieces:
Whom can the doctor talk to? Who can make the decision? And what would you want that decision to be? Three different questions. Three different jobs. And three things your adult child now gets to decide for themselves.
Before we move on, though, I want to mention one important legal restriction when it comes to advance directives and end-of-life decisions. Depending on where you live, state law may limit the ability to follow an advance directive, or an agent's ability to make certain end-of-life decisions, during pregnancy.
I've devoted an entire episode to this issue when I discussed the story of Adriana Smith, I'll link to that episode in the show notes if you want to learn more.
For now, let's come back to the three words I want you to remember from this episode: Information. Authority. And Wishes.
So when my daughter turns 18, I don't want to sit her down and say, "Here are three documents I need you to sign so that I can still help you."
I want to say something more like: "You're an adult now. And one of the things you get to decide as an adult is whom you trust. Whom do you want your doctors to be able to talk to? Whom would you trust to make medical decisions for you if you couldn't make them yourself? And what would you want that person to know?"
And here's another suggestion: Go first. Tell your child what you've decided. Instead of opening with, "We need to talk about what happens if you're dying," you might say:
"I've made these decisions for myself. Your dad is the person I've chosen to make healthcare decisions for me. We've talked about what I would want if I couldn't make those decisions myself. And now that you're 18, you get to make those choices for yourself, too."
That's a very different conversation. You're not predicting that something terrible is going to happen. You're teaching your child one more piece of being an adult. And you're showing them that this isn't something we ask 18-year-olds to do because they're going off into a dangerous world. It's something we do, too.
There's one more practical issue if your child is heading off to college in another state. Your child may be a resident of one state but actually receive medical care in another.
Healthcare documents executed in one state may be recognized elsewhere, depending on applicable state law. But in an emergency, my goal isn't merely to have a document that ultimately can be determined to be valid. I want to make things as easy as possible for the healthcare providers who need to use it.
So if your child is living or attending school in another state, consider whether it makes sense to also complete that state's forms. If my child ended up unconscious in an emergency room hundreds of miles away, I wouldn't want the medical team spending unnecessary time figuring out whether an unfamiliar out-of-state document can be relied upon. I'd rather hand them something they recognize.
Now, I want to pause here because you may be thinking: Wait. If my 18-year-old doesn't have a healthcare power of attorney, surely the hospital isn't just going to throw up its hands and say, "Well, I guess no one can make a decision."
And you're right, sort of. Some states have different laws for dealing with this situation. Tennessee, where I practice, has a backup system. If a patient can't make their own healthcare decisions and hasn't named someone to make those decisions for them, Tennessee law allows the supervising healthcare provider to identify a surrogate.
The law gives the healthcare provider some guidance. A spouse gets preference, followed by an adult child, a parent, an adult sibling, other relatives and then potentially another adult. But it's not quite as simple as just moving down a list.
The healthcare provider also has to consider who knows the patient best, who understands their wishes, who has been involved in their life, who's demonstrated care and concern, and who's actually available to work with the medical team. Think about the position that puts the healthcare provider in.
Your child is lying in a hospital bed, unable to make their own decisions, and now someone on the healthcare team may have to sort through the family relationships and determine who is best qualified to speak for them. And what if Mom and Dad disagree? What if a parent and a sibling disagree about what the patient would want? What if two people both believe they're the person who knows the patient best?
Tennessee law gives us a mechanism for dealing with the absence of a healthcare power of attorney. But a statutory backup plan isn't necessarily the plan you would choose.
I wouldn’t want the doctors caring for someone I love spending their time trying to sort through their family's dynamics. I would want them focused on the patient. A healthcare power of attorney allows you to make that part easy.
And, once the documents are signed, don't just put the documents in a drawer somewhere and forget about them. Make sure the people your child named know they've been named and that they can access the documents if they’re ever needed.
We tend to think of estate planning as something you do when you're older. When you buy a house, get married, have kids, make more money. But turning 18 offers a really important introduction to estate planning. Likely, your child's first estate planning decision has nothing to do with money. But they do have something important to plan for: themselves. Information, Authority and Wishes.
That's estate planning, too. And it's one of the first opportunities we have to teach our kids that becoming an adult doesn't mean you suddenly know how to handle everything yourself. It means you get to decide whom you trust to stand beside you when you can't.
When my daughter turns 18, she'll get to make these decisions too. And that's really what this episode is about. Not parents holding on, but knowing when to help our children take control of their own decisions—and loving them enough to listen to what they choose.
Thanks for listening today.
This is Death Readiness, real, messy and yours to own. I’m Jill Mastroianni and I’m here to help you sort through it, especially when you don’t know where to start.
Hi, I'm April, Jill's daughter. Thanks for listening to The Death Readiness Podcast. While my mom is an attorney, she’s not your attorney. The Death Readiness Podcast is for educational and entertainment purposes only. It does not provide legal advice. For legal guidance tailored to your unique situation, consult with a licensed attorney in your state. To learn more about the services my mom offers, visit DeathReadiness.com.
