standard application letter for

How to Write an Application Letter (Sample Included!)

Whether you’re applying for a job , internship , scholarship, or volunteer position, a well-crafted application letter can help you stand out. It's your chance to introduce yourself and make a strong first impression that sets you apart from the competition.

But how do you write an application letter that’s effective? Below, we’ll explain when to use this method of introduction and give you practical tips on writing one that gets results. Plus, we've included a sample application letter and a template to help you create the perfect document for any opportunity.

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What is an application letter?

An application letter is a document sent with your resume to provide additional information on your skills and experience. It's a crucial part of an application for work as it introduces you to potential employers and highlights your qualifications.

While some companies request it at the beginning of the application process, others might ask for it later, or not at all—but it's always a valuable addition.

Unlike a resume, which outlines your work history, a written application allows you to elaborate on your achievements and how they relate to the job you are applying for. It is a much more specific way to introduce yourself and explain why you would be a good fit for the job.

How is an application letter different from a cover letter?

Some people use the terms “application letter” and “cover letter” interchangeably, but there are subtle differences between the two.

An application letter serves as your formal introduction to a potential employer. It highlights your interest in the role, your qualifications, and why you're a good fit for the position. It's a standalone document that provides a comprehensive overview of your skills and experiences.

On the other hand, a cover letter is usually more concise than an application letter and serves as a complementary document to your resume, providing additional context to your job application. It elaborates on specific points from your resume and explains how your background aligns with the job requirements.

Also, job application letters follow a more formal structure, often resembling a traditional business letter. They include your contact information, the date, and the employer’s contact information at the top. An application letter is usually addressed to a specific individual, such as the hiring manager or recruiter. While cover letters also have a professional tone, they can be less formal in structure.

Finally, the application letter is used primarily for job applications, internship applications, scholarship applications, and volunteer positions. In contrast, the cover letter is specifically used to accompany a resume during job applications.

When do you need to send an application letter?

Application letters are typically required when applying for jobs. However, there are other scenarios where you might need one:

• Scholarship applications: When applying for scholarships, this kind of letter can help you stand out by showcasing your academic achievements and career goals .
• Volunteer positions: Some volunteer organizations require an application letter to understand your motivations and skills relevant to the position.
• Internship applications: Internships often require this document to understand your interest in the role and what you hope to gain from the experience.
• Networking purposes: Sending one when reaching out to potential mentors or industry professionals can help you establish a connection and explain your career aspirations.

7 tips on how to write a job application letter

Writing an effective application letter involves more than just summarizing your resume. Here are seven tips to write yours:

1. Research the company—at least do a quick Google search!

Before you start writing, research the company to understand its culture, values, and needs. Tailor your letter to align with the company’s mission and the job description. There is nothing better for an HR professional than feeling that you don’t just want any job; you want to work with them for specific reasons, such as X and Y.

“Address the letter to the hiring manager by name if possible,” says Mike Chappell, CEO of FormsPal , who has more than a decade of experience reviewing application letters. “This shows that you’ve done your research and are genuinely interested in the company.”

2. Use a professional format and design

Your application letter should follow a formal letter of application format. Use a standard font like Times New Roman or Arial, and keep the font size between 10 and 12 points. Include your contact information, the date, and the employer’s contact information at the top of the letter.

There are many layouts online that you can use. Find one that represents your style and complements your resume.

3. Make it engaging from the start with a strong opening

Your opening paragraph should grab the reader’s attention. Mention the position you're applying for and where you found the job listing. If you were referred by someone, include their name. Briefly introduce yourself and explain why you’re interested in the role.

4. Highlight your qualifications—what you can’t fully convey in your resume

In the body of your applicant letter, highlight your relevant skills, experiences, and achievements. “Use specific examples to showcase your accomplishments and how they relate to the job you’re applying for,” Chappell says. “ Quantifiable results can make a strong impact.”

Avoid repeating information from your resume; instead, expand on your most relevant experiences.

5. Show enthusiasm and genuine interest

Employers want to hire candidates who are enthusiastic about the role and the company. Show your excitement for the opportunity. Explain why you are specifically interested in this job and how it aligns with your career goals.

6. Keep it concise

While it’s important to provide enough detail, your application letter should be concise. Aim for one page, with three to four paragraphs. Be clear and to the point, avoiding unnecessary fluff.

7. Proofread carefully

Typos and grammatical errors can leave a negative impression on employers. Carefully proofread your letter before sending it. Consider asking another person to review it as well.

Letter of application sample

Here's a super complete example of application letter to help you get started:

August 1, 2024

Ms. Jane Doe

Hiring Manager

Innovative Solutions Inc.

456 Maple Avenue

Springfield, IL 62705

Dear Ms. Doe,

I am writing to express my interest in the Marketing Manager position at Innovative Solutions Inc., as advertised on your company’s careers page. With more than five years of experience in marketing and a proven track record of successful campaigns, I am excited about the opportunity to contribute to your team and drive impactful marketing strategies.

In my previous role as a Senior Marketing Specialist at Creative Solutions LLC, I led a team in developing and executing a comprehensive marketing strategy that resulted in a 30% increase in brand awareness and a 25% boost in lead generation. My responsibilities included overseeing digital marketing campaigns, analyzing market trends, and coordinating with cross-functional teams to ensure alignment with overall business goals. This experience has honed my skills in strategic planning, data analysis, and team leadership.

I am particularly impressed by Innovative Solutions Inc.’s commitment to leveraging cutting-edge technology to deliver innovative marketing solutions. Your recent campaign, which utilized artificial intelligence to optimize ad targeting, is a testament to your forward-thinking approach. I am eager to bring my expertise in digital marketing and campaign management to your team and contribute to similar groundbreaking projects.

My strong analytical skills, combined with my ability to lead and inspire a team, make me a great fit for this role. I am confident that my background and enthusiasm for innovative marketing strategies align well with the needs of Innovative Solutions Inc.

Thank you for considering my application. I look forward to the opportunity to discuss how my skills and experiences can contribute to the continued success of Innovative Solutions Inc.

123 Elm Street

Springfield, IL 62704

[email protected]

(555) 123-4567

Template for an application letter

You can also use the following application format to structure your application letter for a job:

[Recipient’s name]

[Company’s name]

[Company’s address]

[City, State, ZIP Code]

Dear [Recipient’s name],

I am writing to express my interest in the [Job title] position at [Company name] as advertised on [Where you found the job listing]. With my background in [Field or industry] and a passion for [Specific aspect of the job or industry], I am excited about the opportunity to contribute to your team.

In my previous role at [Previous company], I developed [Specific skills or achievements]. I successfully [Describe a project or responsibility], which resulted in [Quantifiable result or achievement]. This experience has equipped me with [Relevant skills] that I am eager to bring to [Company name].

I am particularly impressed by [Company name]’s commitment to [Specific company initiative or value], and I am enthusiastic about the prospect of working with a team that values [Related value or skill]. I am confident that my skills and experiences align well with the requirements of the [Job title] position.

Thank you for considering my application. I look forward to the opportunity to discuss how my background, skills, and enthusiasm can contribute to the success of [Company Name].

[Your Name]

[Your address]

[Your email address]

[Your phone number]

Common mistakes to avoid

When writing a letter of application for employment, be aware of these common mistakes:

• Being too generic: Focus your letter on the specific job and company, and mention detailed information about them. Don’t default to a one-size-fits-all approach or AI-written document. “It is generally best to avoid using generative AI to write your application letters for you,” says Edward Tian, CEO of AI detector GPTZero . “Only you can write about those specific aspects of your identity and experiences in such a personal way.”
• Focusing too much on yourself: While it’s important to highlight your qualifications, make sure to explain how you can benefit the company. “You can talk about your career goals, college classes that piqued your interest in the type of job you're applying to—just make sure that they tie into why they make you uniquely qualified or well-positioned for the job,” Tian says.
• Including irrelevant information: Avoid discussing unrelated jobs or hobbies, for example.
• Using a casual tone: Maintain a professional tone throughout your letter. Avoid slang or overly casual language.

Need a bit more guidance in your job search? Read this next: How to Apply for a Job Online: 10 Tips to Stand Out and Land an Interview

How to Write an Effective Application Letter [with Example & Tips]

By Sheila Kravitz

11 min read

An application letter is a vital document in any job seeker’s arsenal, at the same level of importance as resumes and cover letters. It’s often an applicant’s first point of contact with recruiters and hiring managers .

So, how do you write an effective job application letter to highlight your skills and experience, capture the potential employer’s attention, and increase your chances of getting a job? These are the questions that we’re going to answer in this article while also giving you concrete examples and expert tips that’ll make your letter shine.

Without further ado, let’s jump right in!

Key Takeaways

An application letter is a document similar to a cover letter or a resume that job seekers submit when they are interested in a role .

The document is similar to a cover letter example , and it should follow business letter formatting .

Before writing an application letter, you should research the company and read the job ad to find out which skills and qualifications are needed.

An introductory paragraph should be attention-grabbing , highlighting the amount of work experience you have and at least one highly impressive accomplishment.

The middle portion of the document should be all about your skills and achievements relevant to the job.

A call to action toward the end of the letter increases your chances of being invited for an interview.

What is a Job Application Letter?

A job application letter is a document that’s in many ways similar to a cover letter. It’s written and sent with the purpose of applying for a job . As such, it should convey valuable information about your skills, experience, and motivation for the role that you’re applying for.

However, while a cover letter is a supplementary document to a resume , a job application letter is typically a standalone document and should be sent without additional attachments. As a result, it needs to be longer and more detailed than a cover letter.

Still, an application letter should be a concise, one-page document that serves as an elevator pitch. Use it to get in touch with potential employers and make a lasting first impression that can secure you an interview and expedite the hiring process.

The Best Way to Format Your Job Application Letter

The best way to format your job application letter is to follow the business letter format and layout . This includes organizing the information in a specific way and ensuring that your document is visually clean.

Here’s how to arrange the information in your application letter:

Job Application Letter Format

Contact information

A formal salutation

A catchy introductory paragraph

The middle portion, with your skills and achievements

A closing paragraph with a call to action

A cordial letter closing with your sign-off

This is the optimal structure to follow when writing a job application letter, as it gives hiring managers the chance to see what they want to see exactly when they want to.

Now let’s see how you can create an impeccable layout for your application letter:

Job Application Letter Layout Guidelines

Your document should be one page long .

Choose an appropriate font for your application letter, like Calibri or Helvetica.

Set the font size between 10 and 12 pt.

Adjust margins to at least 1 inch on all sides.

Use 1.0 or 1.15 line spacing and insert an additional line between paragraphs.

Align text to the left or use justified alignment.

A Step-by-Step Guide to Writing a Perfect Application Letter

Let’s learn how to write an application letter for a job with a step-by-step guide that’ll show you how to craft every part of it.

#1. Research the Company

Researching the company is the first step before you even start writing your application letter . This is crucial, as your document has the best chance of garnering attention from hiring managers if it’s tailored and relevant to the position that you’re applying for.

That’s because every job is different, and even similar roles within the same industry require different sets of skills and experiences. By looking into the organization that you want to join, examining the job ad, and paying attention to the requirements, you’ll be able to pinpoint exactly what hiring managers and employers look for in candidates .

After that, you’ll be able to lean on those experiences, as well as the hard and soft skills that you know are necessary for the job. That’ll set you apart from other candidates with generic application letters that don’t entirely match the posted requirements.

#2. Write an Introduction

Writing a strong introductory paragraph is one of the most important steps in the process of crafting an application letter. It’s your way of grabbing the reader’s attention and persuading them to check out the rest of your document.

Hiring managers are busy professionals and sometimes merely skim through application letters , spending just a couple of seconds on each. That’s why you want the first few sentences to be as captivating as possible.

Use this paragraph to mention the position that you’re applying for, emphasize how much experience you have , and highlight one or two particularly notable accomplishments.

Here’s an example:

Introduction Example

I am writing to express my interest in the architect position at Sky Vision Inc., as advertised on your website. With more than 11 years of experience in residential design and project management, as well as a Global Award for Sustainable Architecture under my belt, I am confident that I’ll be able to contribute to your esteemed organization and lead your large-scale projects.

#3. Emphasize Your Skills & Achievements

Once you have the hiring manager’s attention, it’s time to impress them with your unique skills and achievements . Remember that the goal is to be as relevant as possible, so focus on those accomplishments that indicate how you are going to perform in their company should they hire you.

One of the best ways to make this part of your application letter pop is to use numbers for quantification . They add measurable value to your accomplishments, adding credibility to them and making them stand out in the eyes of hiring managers.

Let’s see that in an example:

Emphasize Skills & Achievements Example

I have a proven track record of handling more than 50 projects from inception to completion, within budget, and with no missed deadlines. One of my biggest accomplishments was carrying out a $35 million project and achieving a delivery time 13% faster than the industry standard.

#4. Say Why You’re a Good Fit for the Role

In addition to accentuating your skills and experience, you should stress that you’re the perfect person for the role you’re applying for. This builds on the summary of qualifications that you already talked about to show potential employers how they are going to benefit from hiring you .

To achieve this goal, you can point out the moments when your previous employers prospered from your work , such as how you helped them gain new clients, boost their revenue, improve their business, and more.

Why You’re a Good Fit for the Role Example

Exceptional skills in design software like AutoCAD and Revit, coupled with a commitment to green and user-centric architecture, garnered me a 96% user satisfaction rate and an increase in the company’s repeat business by 67%.

#5. Close Your Letter With a CTA

You should take the opportunity to include a call to action (CTA) toward the end of your application letter. A CTA is a marketing term describing something created to elicit a response .

In terms of an application letter, a CTA can be an invitation for hiring managers to contact you for a job interview . This one simple sentence can vastly improve your chances and secure you the next step in the hiring process.

Close the Letter With CTA Example

Thank you for your time. I would love the opportunity to discuss my qualifications over an interview and explain further how I could contribute to your organization.

Let’s put what we’ve learned into practice and check out a complete application letter example :

Application Letter Example

3 Tips for Crafting an Effective Job Application Letter

Let’s wrap it up with a couple of expert tips that’ll help you craft the best application letter for a job vacancy:

Job Application Letter Writing Tips

Show that you’re interested in the company. Mention something specific about the organization that you want to join that compelled you to apply to them in particular. That’ll set you apart from the competition, as it shows true passion and indicates that you’re already familiar with their work.

Address the reader by their name. Greeting the reader by their name creates a connection right from the get-go. It’s a great way to build rapport and show that you went the extra mile to research the company.

Write a new job application letter for every position. Don’t submit the same application letter every time you apply for a new job. Even slight modifications can still make your document look generic. For maximum chances with recruiters, your best bet is to write a new one every time.

Final Thoughts

Writing a strong application letter is a skill in and of itself. It represents a combination of research skills, communication skills , writing skills , attention to detail, and more. However, learning this ability is crucial, as it opens doors to invaluable opportunities and helps you move your career in the right direction.

Fortunately, learning to write this document is not that difficult once you understand the basics . The format and layout remain the same, regardless of the career or role that you’re applying for. One application letter sample works for any position; you just need to adapt it to suit your needs.

That’s why we’ve provided step-by-step instructions and a complete example of an application letter, arming you with all the knowledge you need. Best of luck getting the job of your dreams!

Application Letter FAQ

#1. when do you need a job application letter.

You need a job application letter when you’re applying for a role , and you want to stand out among the competition. This document serves as a testament to your skills and experience, and its goal is to portray you as a qualified candidate who’s perfect for the job.

#2. Is a letter of application the same as a cover letter?

A letter of application is not the same as a cover letter , but they share many similarities. The two documents have the same formatting, and both convey valuable information about your competence. However, a cover letter supplements your resume, while an application letter is a standalone and more comprehensive document.

#3. How do I write an application letter that stands out?

To write an application letter that stands out, focus on the skills and accomplishments that are relevant to the job that you’re applying for . Use an attention-grabbing introductory paragraph and include a call to action toward the end. Finally, leverage numbers to add measurable value to your achievements.

Create your cover letter once, use it everywhere

Jobscan > Cover Letter Examples

Cover Letter Examples for Job Seekers in 2024

With so many different types of jobs out there, it can be tough to know how to tailor your cover letter. But by following these examples, you'll be able to write a cover letter that will make you stand out from the crowd!

Customers interviewed with:

If you think cover letters are no longer relevant in today’s job market, think again. According to a recent survey , 83% of hiring managers say cover letters play an important role in their decision-making process.

In fact, 83% of the respondents to the survey said that a great cover letter can get you an interview , even if your resume isn’t good enough .

Amazingly, only 38% of candidates send a cover letter, even when it’s required .

This means that a strong cover letter will give you a significant edge over other job applicants. So if you’re not already including a cover letter with your job applications, it’s time to start doing so.

In this guide, we’ll provide some tips on how to write an effective cover letter , as well as some good cover letter examples to help get you started.

NEW! Jobscan has recently added an AI-powered cover letter generator . This tool uses GPT-4 technology to create a personalized and ATS-friendly cover letter in just one click .

There are four types of cover letters. They are:

• The application cover letter
• The career change cover letter
• The networking cover letter
• The prospecting cover letter

The general structure of all four cover letters will remain the same, or at least similar, regardless of your cover letter’s intent. This structure can be broken down into three steps:

Step 1 – Introduce yourself and explain why you are interested in the position.

Step 2 – Highlight your relevant skills and experience.

Step 3 – Thank the employer for their time and express your interest in meeting with them to discuss the role further.

Here are examples of the four types of cover letters. Each example can all be downloaded for free and customized to fit your needs.

Application Cover Letter Example

This is the standard cover letter you send along with your resume when you apply for a job. It supplements your resume and expands upon relevant parts of your work history and qualifications. It’s important to tailor your cover letter to the skills and specifications listed in the job posting.

Career Change Cover Letter Example

This cover letter explains that you’re hoping to move your career in a new direction. It should express your interest in the company, then pull several responsibilities from the job description and explain how your skills will uniquely fulfill those responsibilities and add value to the company.

Prospecting Cover Letter Example

This type of cover letter inquires about open job positions in general. It is not a response to a specific job posting. In this letter, you should give a brief description of yourself as a job candidate, explain why this particular company interests you, and include a few examples of job tasks you would excel at.

Networking Cover Letter Example

This cover letter is the most casual and tends to be the shortest. You send it to former colleagues, mentors, friends, and other contacts rather than to a company. It informs the recipient of your status as a job seeker and asks them for help in your job search.

Cover letter examples by job

When you’re applying for a specific job, remember that your cover letter should not simply repeat the information in your resume verbatim. Instead, your cover letter should enhance your resume .

For example, you might use your cover letter to explain why you are particularly interested in the company, or to highlight a specific skill or accomplishment . In essence, your cover letter should give the employer a better sense of who you are and what you have to offer.

Here are some professional cover letter examples tailored for specific jobs. Each example can all be downloaded for free and customized to fit your needs.

Communications Specialist Cover Letter Example

Show how you effectively communicate with others. Be sure to highlight your oral and written communication skills, as well as your ability to develop and deliver presentations. Also, emphasize any experience you have working in the media or with public relations.

Employment Specialist Cover Letter Example

Focus on your ability to help people find jobs and improve their career prospects. Highlight your skills in counseling, resume writing, and job search strategies. You should also emphasize your commitment to helping people overcome obstacles and achieve their goals.

Project Manager Cover Letter Example

Showcase your proven track record of successful project management. Use numbers and metrics as evidence of your ability. In addition to relevant experience, highlight your leadership, organizational, and communication skills.

Marketing Manager Cover Letter Example

Talk about your experience using various marketing strategies, your ability to identify target markets, and your success in creating and implementing marketing campaigns. Also highlight your writing and communication skills, as well as your ability to manage people and projects.

Operations Cover Letter Example

Discuss your training and experience in the operations field, as well as your ability to manage and coordinate various types of operations. Also highlight your problem-solving skills and ability to work effectively under pressure.

Pharmacy Technician Cover Letter Example

Highlight your ability to accurately dispense medication, maintain records, and assist customers or patients. Also, mention your ability to work well under pressure and follow set procedures. If you have any additional certifications or training, be sure to mention those as well.

Software Engineer Cover Letter Example

Talk about your skills and experience designing, developing, testing, and debugging software applications. Highlight your ability to work in a team environment and contribute to the success of projects. Also mention any relevant coursework or projects you have completed, as well as any relevant awards or recognitions.

Warehouse Manager Cover Letter Example

Discuss your experience managing inventory, overseeing shipping and receiving operations, your knowledge of safety procedures, and your organizational skills. You should also highlight skills such as supervising employees and knowledge of warehouse management software.

Writing a cover letter for an internship can be a little tricky since you probably don’t have much experience. Here are four tips to help you create an effective cover letter for an internship:

• Focus on what you have accomplished in your academic and extracurricular activities, and how those experiences have prepared you for the internship.
• Do your research and tailor your cover letter to the specific organization and internship role. This will demonstrate your interest and commitment.
• Highlight any relevant skills or experiences that you do have, even if they’re not directly related to the internship role.
• Finally, be enthusiastic and convey your excitement for the opportunity to learn and grow in the role.

By following these tips, you can write a cover letter that will help you land the internship you’re after.

Here’s a sample cover letter for an internship:

Internship Cover Letter Example

Use your cover letter to explain why you are interested in the internship and how it will help you develop professionally. Include information about your qualifications and skills, as well as your interest in the specific internship you are applying for.

One of the biggest mistakes job seekers make is sending out the same cover letter with each application.

A cover letter is an opportunity to sell yourself to a potential employer, and it should be specific to the job you’re applying for. Generic cover letters are often quickly disregarded by hiring managers, but a well-tailored cover letter can make all the difference.

Another reason why you should tailor your cover letter is because of applicant tracking systems (ATS). Many companies now use these systems to screen candidates, and generic cover letters are often filtered out.

To avoid this, make sure that your cover letter contains the exact same job title and skills that are in the job description. This way, when hiring managers search through the ATS for job candidates, your cover letter will stand out.

If you’re not sure whether your cover letter is properly tailored to the job you’re applying to, run it through Jobcan’s cover letter checker . It analyzes your cover letter and compares it to the job listing to identify the key skills and qualifications that recruiters are looking for.

You’ll get personalized feedback on how to improve your cover letter and make it more compelling to employers.

What do I write in a cover letter?

While your resume is typically a factual account of your qualifications, a cover letter allows you to tell a potential employer why you are the best candidate for the job .

Your cover letter is an opportunity for you to:

• Elaborate on your qualifications and professional experience.
• Describe your career objectives.
• Explain any gaps in your employment history.
• Talk about your motivation to join the company.
• Sell yourself!

It is important to take the time to craft a well-written cover letter as it can give you a competitive edge over other candidates.

What 5 things should a cover letter include?

Here are the five essential elements of a cover letter:

• An introduction : The first sentence of your cover letter should state who you are and why you are writing.
• An overview of your qualifications : In the second paragraph, briefly describe your qualifications and explain why you are a good fit for the position.
• A specific example : In the third paragraph, provide a specific example of a time when you used your skills to achieve success. This could be from your professional or personal life.
• A call to action : The final paragraph should include a call to action , such as requesting an interview or asking for further consideration.
• A professional closing : End your cover letter on a positive note by thanking the reader for their time and expressing your excitement about the opportunity.

What 3 main points should be included in your cover letter?

• Briefly introduce yourself and explain why you are interested in the position. This is your chance to make a good first impression, so be sure to be polite and professional.
• Highlight your relevant qualifications and experience. This is where you can really sell yourself as the ideal candidate for the job. Be sure to include specific examples of your successes and accomplishments.
• Thank the employer for their time and consideration. Then, you can express your interest in meeting with them to discuss the job further.

By following these guidelines, you can ensure that your cover letter makes a strong impression and increases your chances of landing an interview.

How do I write a cover letter as a student?

As a student, you should treat your education, volunteer work, school projects, and personal projects as your past experience. Talk about your future goals that are relevant to the job and explain how you will achieve those goals.

How do cover letters vary from job to job?

While the general structure of your cover letter will remain pretty much the same, you should always tailor your letter for each job you apply to. This means including the job title and skills that are listed in the job description.

How do I write a cover letter for a career change?

Read the job posting carefully and determine any similarities between your past work experience and what’s required in the new job. Talk about your goals for your career change and what you want to accomplish in your future career.

What is the difference between a cover letter and a resume?

Your resume is a brief listing of your past experience, while your cover letter expands on your experience and lets some of your personality come through.

Should I mention my salary expectations in a cover letter?

No. Conversations about salary should be reserved for a job interview.

How should I address the reader of a cover letter?

Always try to address the hiring manager or recruiter by their name . You can call the company and ask for their name or look it up on the company website or LinkedIn. Never use “To Whom it May Concern” as it is too impersonal.

How long should my cover letter be?

Cover letters should always be short. Try to keep it to one page.

Explore more cover letter resources

Cover Letter Writing Guide

Cover Letter Tips

Cover Letter Examples

Cover Letter Templates

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Sample Cover Letter for a Job Application

What Is an Application Letter?

What to include in your application letter, tips for writing a cover letter, cover letter sample and template, email cover letter sample.

• How to Send an Email Application

Frequently Asked Questions (FAQs)

Alex Dos Diaz / The Balance

What's the best way to write a letter to apply for a job? Your letter should detail your specific qualifications for the position and the skills you would bring to the employer. What’s most important is to show the employer that you’re a perfect match for the job.

Your job application letter is an opportunity to highlight your most relevant qualifications and experience. An effective cover letter will enhance your application, showcase your achievements, and increase your chances of landing an interview.

Review what to include in a job application letter, tips for writing that will get your application noticed, and examples of cover letters and email messages to send when applying for a job.

Key Takeaways

• An application letter accompanies a resume and may be uploaded to a job portal, sent via email, or even sent by postal mail, depending on the employer’s requirements.
• Application letters are an ideal way to show your interest in a job and highlight your most relevant skills.
• It’s important to match your letter to the job description and show the employer you have the qualifications they are seeking.

A   letter of application, also known as a  cover letter , is a document sent with your resume to provide additional information about your skills and experience to an employer. Your letter of application is intended to provide detailed information on why you are an ideal candidate for the job.

Your application letter should let the employer know what position you are applying for, what makes you a strong candidate, why they should select you for an interview, and how you will follow up.

Effective application letters explain the reasons for your interest in the specific organization and identify the most relevant skills that qualify you for the job.

Unless an employer specifically requests a job application letter sent by postal mail, most cover letters today are sent by email or attached as a file in an online application tracking system.

As with all cover letters, a job application letter is divided into sections:

• The heading includes your name and contact information.
• A  greeting  addressed to a specific person, if possible.
• The introduction includes why the applicant is writing.
• The body discusses your relevant qualifications and what you have to offer the employer.
• The close thanks the reader and provides contact information and follow-up details.
• Your  signature to end the letter .

Here’s how to ensure your application supports your resume, highlights your most relevant qualifications, and impresses the hiring manager.

Get off to a direct start.  In your first paragraph, explain why you are writing. Mention the job title, company name, and where you found the job listing. While you can also briefly mention why you are a strong candidate, this section should be short and to the point.

Offer something different than what's in your resume. You can make your language a bit more personal than in your resume bullet points, and you can tell a narrative about your work experience and career.

Application letters typically accompany resumes, so your letter should showcase information that your resume doesn't.

Make a good case.  Your first goal with this letter is to progress to the next step: an interview. Your overarching goal, of course, is to get a job offer. Use your application letter to further both causes. Offer details about your experience and background that show why you are a good candidate. How have other jobs prepared you for the position? What would you bring to the role and the company? Use this space to  emphasize your strengths .

Close with all the important details.  Include a thank you at the end of your letter. You can also share your contact information and mention how you will follow up.

This is a sample cover letter.  Download the cover letter template  (compatible with Google Docs and Word Online) or see below for an email sample.

The Balance

John Donaldson 8 Sue Circle Smithtown, CA 08067 909-555-5555 john.donaldson@email.com

September 6, 2023

George Gilhooley LTC Company 87 Delaware Road Hatfield, CA 08065

Dear Mr. Gilhooley,

I am writing to apply for the programmer position advertised in the Times Union. As requested, I enclose my certification, resume, and references.

The role is very appealing to me, and I believe that my strong technical experience and education make me a highly competitive candidate for this position. My key strengths that would support my success in this position include:

• I have successfully designed, developed, and supported live-use applications.
• I strive continually for excellence.
• I provide exceptional contributions to customer service for all customers.

With a BS degree in computer programming, I have a comprehensive understanding of the full lifecycle of software development projects. I also have experience in learning and applying new technologies as appropriate. Please see my resume for additional information on my experience.

I can be reached anytime via email at john.donaldson@email.com or by phone at 909-555-5555.

Thank you for your time and consideration. I look forward to speaking with you about this employment opportunity.

Signature  (only if a hard copy letter)

John Donaldson

The following is a sample email cover letter to send as part of a job application.

Email Application Letter Example

Subject: Colleen Warren - Web Content Manager Position

Dear Hiring Manager,

I'm writing to express my interest in the Web Content Manager position listed on Monster.com. I have experience building large, consumer-focused, health-based content sites. While much of my experience has been in the business world, I understand the social value of this sector, and I am confident that my business experience will be an asset to your organization.

My responsibilities have included the development and management of website editorial voice and style, editorial calendars, and the daily content programming and production for various websites.

I have worked closely with health care professionals and medical editors to provide the best possible information to a consumer audience of patients. I have also helped physicians use their medical content to write user-friendly and easily comprehensible text.

Experience has taught me how to build strong relationships with all departments in an organization. I have the ability to work within a team, as well as cross-team. I can work with web engineers to resolve technical issues and implement technical enhancements. 

I am confident working with development departments to implement design and functional enhancements, monitor site statistics, and conduct search engine optimization.

Thank you for your consideration.

Colleen Warren colleen.warren@email.com 555-123-1234 www.linked.com/colleenwarren

How to Send an Email Application Letter

If sending your cover letter via email, list your name and the job title you are applying for in the  subject line  of the email:

Colleen Warren - Web Content Manager Position

Include your contact information in your email signature but don't list the employer's contact information.

Do you have to write a cover letter when you apply for a job?

Some employers require cover letters. If they do, it will be mentioned in the job posting. Otherwise, it’s optional but it can help your chances of securing an interview. A cover letter gives you a chance to sell yourself to the employer, showcase your qualifications, and explain why you are a perfect candidate for the job.

How can you use a cover letter to show you’re a qualified candidate?

One of the easiest ways to show an employer how you’re qualified for a job is to make a list of the requirements listed in the job posting and match them to your resume . Mention your most relevant qualifications in your cover letter, so the hiring manager can see, at a glance, that you have the credentials they are looking for.

CareerOneStop. " How Do I Write a Cover Letter? "

Job Application Letter

Job application letter maker.

A Job Application Letter is a critical tool for making a positive first impression on potential employers. It’s your chance to showcase your skills and enthusiasm for the position. This guide, complete with letter examples , will walk you through the process of creating a compelling application letter. You’ll learn how to highlight your experiences effectively, tailor your letter to specific jobs, and stand out from other applicants. With these tips and examples, crafting a job application letter that grabs attention becomes an achievable goal.

Download Job Application Letter Bundle

Before you can be considered for a recruitment interview, there are several materials that you need to hand to the employer. One of these is the job application letter. This document accompanies your resume in terms of giving information about your qualifications and other deliverable. We have come up with a list of downloadable job application letters that you can use as guides and references. Browse through them so you can come up with a well-structured, impressive and efficient job application letter.

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Job Application Letter for Company

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Job Application Letter – Sample and Tips Example

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Good Application Letter Example

Application Letter / Cover Letter Example

Do You Really Need a Job Application Letter?

It is already common knowledge that a resume is one of the most essential items that you need to prepare whenever you plan to apply for a job. However, it is not the only document that can affect the decisions of employers. Aside from a reference letter  written by another person, you can also create another letter that can help you in your application.

A job application letter, or a cover letter , can also greatly impact the way employers look at you as a candidate. If you can create a comprehensive and strategically-formulated cover letter, then you can have higher chances of getting a call for an interview or for the next phases of the recruitment. Here are some of the reasons why we think that making a job application letter should also be prioritized whenever you plan to immerse in the processes of searching and applying for vacant job positions open for employment:

• A job application letter can help you easily target the demands of the work position. If there are already specifications with the minimum requirements of the job designation, your job application can provide information and instances that are aligned with what the company is looking for. Even if a resume can also do this, a job application letter is actually more thorough as it allows you to be more detailed when discussing your deliverable. You may also see email cover letter examples .
• A job application letter can make you more desirable as a candidate. This document does not only present your skills and potential. You can also specify the items that you know about the business and its operations. Through this, you can already discuss how you can help the business achieve its goals. If the business can create the perception that you are truly knowledgeable of the specifics of the work position and why you deserve to be hired, then more interest can be given to your application. You may also like business proposal letter examples .
• A job application letter can market your professional qualifications. The further you explain what employers can expect from you, the more they can have an overview of how you can add value to the business. This is the reason why you have to be strategic when placing information in the job application letter. As much as possible, include information that are highly-related to the work post that you are targeting and those that are directly aligned with the corporate vision, mission and objective of the company.

Cover Letter / Job Application Letter – Guidelines and Example

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Job Application Letter / Cover Letter Template Example

Simple Job Application Letter Example

Basic Job Application Letter Example

How to Prepare Yourself Before Writing a Job Application Letter

If you want to receive a job appointment letter at the end of the recruitment process, you have to ensure that all the documents that you will submit during your application are on point. The process of developing the content, discussion flow and format of your job application letter is very important.

Unlike how others think of it, a job application letter is actually not that easy to do. Yes, you can just write a letter about your desire to apply for a particular work position any time of the day. However, the question that you need to answer is whether the document that you have written can make you standout from your competitors or not. This is why you have to take your time when planning how to come up with an impressive job application letter. Here is how you can prepare yourself whenever you are already prepared to create your own job application letter:

• Understand the task that you have at hand. It is best for you to research about the development of an outstanding job application letter first before making it. The knowledge and thought that you have about this process can make it easier for you to understand what you need to write in the job application letter.
• Make sure that you will have enough relevant information about your prospective employer and the job position that you would like to be hired for. Being knowledgeable of the brand, operational needs and corporate image of the business can help you associate your skills and other qualifications in a more strategic and targeted manner.
• Think of how your job application letter can impact your chances of being noticed by employers. We never know how businesses select their new hires. Do they look at the resumes first before browsing through the job application letter, or the other way around Do they base their impressions just on your professional profile or they also keenly observe the other supplementary documents that you present? Knowing that you have developed a professional, complete and presentable job application letter can make you more confident in the processes of application which can further boost your confidence in the next phases of the recruitment.
• Gather keywords which can be used in the job application letter. These keywords must be related to the industry where the business is a part of, the demands of the work position that you are applying for, the nature of operations of the employer, and the specifics of the daily job functions expected from the work post open for employment. Remember that your job application letter does not need to be technical and full of terms and jargon. However, you should also not forget that it must be informative.

Cover Letter for Job Application Example

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Job Application Letter – Example

Example of a Cover / Application Letter

How to Impress Employers Through Your Job Application Letter

Making a job application letter is a task that you need to seriously immerse yourself into. Some people think that a job application letter is not really necessary as a resume can already present the details that the employers would like to know. However, getting higher chances of a callback does not fully rely on providing what employers need to know but also by supplying them with information that can set the standards for the other applicants. This can easily be done through the development of a job application letter that can further elaborate details that a basic resume with a generic format can’t. Listed below are some of the ways on how you can possibly impress employers once they browse through the job application letter that you have submitted. You may also see acknowledgement letter examples & samples.

• Write the letter in an engaging manner. Ensure that the employers will feel your enthusiasm about the job position that you want to have and the possibility of being a part of the company or the business. You can do this by being aware of the tone and language that you will incorporate in the letter development.
• Present yourself as a candidate who is not just equipped with all the qualifications needed by the job position, but someone who is willing to learn and consistently wants to excel and improve in his or her chosen craft. This allows the company to have an idea that you have an idea about the business and you have selected to apply there because you believe that the possible employment can result to all parties mutually benefit from and with one another. You may also like employee reference letter samples .
• Discuss the key requirements of the job position but veer away from presenting those that are already in your resume. There is no need to create a job application letter if you will just repeat what is already in your professional profile. You need to give the employers more insight of who you are and what you can provide the company with if they decide to hire you. You may also check out what is an application letter?
• Ensure that you can showcase your relevance. List a number of reasons why you are the best candidate for the work position. When stating facts about how your qualifications fit the work description, do not be boastful or overly confident. The discussion must be formal and professional so that you can also make your character shine. Employers do not just look on your professional deliverable as work ethics, character, and adaptability are also important factors that businesses look for in their possible new hires. You might be interested in thank-you letter examples.
• Focus on the formal letter format and presentation of the job application letter as much as you give focus on the document’s content. Make sure that you will come up with an organized discussion. More so, ensure that you will print the document in a clean and business-appropriate paper. If the company asks you to send it through email, do not forget to check if the job application letter has been attached in your message accordingly. You also have the option to properly format the letter in the body of the actual email.

Cover Letter Example

Standard Cover Letter / Application Letter Format Example

Example of a Cover Letter for Work Application

Cover Letter for Work Application Example

Content of a Job Application Letter

Think of your job application letter as a business proposal cover letter . The latter is used to present a blueprint or a plan that can help business transactions between corporate and/or business entities take place. The same goes with the usage of a job application letter. What do you want to present to employers? How do you want to be perceived? Do you think the content of the letter is appealing and impressive enough for an employment transaction to take place? If you can confidently answer these items, then you are on the right track.

The completion of the content in your job application letter must be highly considered. Making a comprehensive job application letter can effectively provide you with a lead advantage during the recruitment and selection process. Here are the important information that you need to include in your job application letter:

• The date when you have written and submitted the job application letter
• The name of the person to whom the job application letter is for and his or her connection to the company
• The business name and other information of the company where you are applying
• A salutation
• The job position that you are applying for
• The statement that you are a great fit for the work position
• The reason why you would like to be hired for the work post by the employer
• The relation of your professional work experiences and deliverable to your desired work position
• The supporting details that can further strengthen your qualifications
• The relevance of your professional expertise to the goals and objective of the business
• A conclusion that should appeal to the employer
• A simple statement that you will be more than willing to progress to the next phases of the hiring process
• A statement that you will be waiting for the response of the employer regarding the matter
• A message of appreciation for the employer’s effort and time to review your application
• Your contact information where the employer may reach you in the future
• A closing remark and your signature

You may also see two weeks notice letter examples & samples.

Job Application Letter for Applicants With a Gap in Career History Example

Cover Letter Layout Example

Cover Letter / Application Letter Template Example

Benefits of Having a Comprehensive and Detailed Job Application Letter

With the stiff competition in different industries, you have to come up with ways and strategies on how you can take a step ahead of other applicants. Always remember that there are limited job opportunities that are targeted by highly-qualified and technically-equipped candidates on a daily basis. Having these in mind can help you prepare better when applying for a job. A job application letter can be one of your strengths during this process. Hence, it is important for you to create this document in the most effective way possible. A few of the benefits that you can have as an applicant if you will create a complete and precise job application letter are as follows:

• Making a job application letter can help you introduce yourself elaborately. You can highlight your key competencies especially those that are not fully-discussed or even placed in your resume summary statement and within the entirety of your professional profile. With this, the employer can give a higher value to your accomplishments and professional experiences. Doing this can also help you showcase instances and real occurrences where your previous employers were able to benefit from your expertise and the execution of your skills in the actual work environment.
• Creating a job application letter can make it possible for you to further express yourself. Why have you chosen the business as your first choice for possible employment? Why do you think you deserve to be hired? What kind of professional work do you want to be involved in? These are only a few of the questions that you can precisely and directly answer in a job application letter. Most resumes are constraining when it comes to the information that you need to include due to the format that you need to follow. This is not the case when making a job application letter as this document contains a conversation-like content in a professional setting. You may also see business letter examples .
• Developing a job application letter can give you the chance to explain the weak areas of your resume. As an example, you can discuss reasons on why you have huge employment gaps or why you decided to resign from one company then to another in a short period of time. However, keep in mind that you should not sound defensive when writing these details as it can also negate the purpose of developing the job application letter which is supposed to impress employers. You may also like reference letter examples.
• Having a job application letter as an essential part of your application strategy can help your qualifications become more tailored with the job position that you are applying for. If you have a job application letter, then you do not need to change a lot of things in your resume as you can already discuss more details in the application letter. Your professional work experiences may not be directly related to the job position that you want. Through the help of a job application letter, you may present the connection of your previous work assignments to the requirements of the new job position that you are applying for. You may also check out appointment letter examples & samples.

Short Job Application Letter Example

Guide and Example of Job Application Letter / Cover Letter

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Cover Letter / Application Letter – Warning w/ Example

Tips to Follow When Developing a Job Application Letter

Creating an effective Job Application Letter is crucial in the job hunting process. This document, often accompanying your resume, is your opportunity to make a strong first impression. Whether you’re crafting a cover letter or a job application email, there are key elements to include for a professional cover letter. Here’s a guide to help you develop an impactful job application letter:

• Understand the Purpose : Your job application letter is more than just a formality. It’s a personal introduction and a pitch. It should complement your resume by highlighting your relevant skills and experiences, tailored to the job you’re applying for.
• Research the Company : Tailoring your letter to the specific company and position is crucial. Show that you have done your homework by mentioning something about the company’s values, culture, or recent achievements.
• Start Strong : The opening of your professional cover letter sets the tone. Begin with a compelling introduction that grabs the reader’s attention. Mention the position you’re applying for and how you discovered the opening.
• Highlight Relevant Skills and Experiences : Use the body of your letter to emphasize why you’re the right fit. Focus on experiences and skills that directly relate to the job description . Use specific examples and quantify your achievements where possible.
• Make it Personal : Avoid generic phrases. Personalize your job application email or letter by reflecting your enthusiasm for the role and explaining why you’re passionate about working for this specific company.
• Keep it Concise and Clear : Your letter should be easy to read and to the point. Aim for no more than one page. Use short paragraphs and bullet points for easy scanning.
• Professional Tone and Language : While you want to show your personality, maintain a professional tone. Use formal language and avoid slang or overly casual phrases.
• Proofread and Edit : Typos and grammatical errors can make a bad impression. Proofread your letter multiple times and consider having someone else review it as well.
• Closing with a Call to Action : End your letter by thanking the employer for considering your application and express your interest in discussing your candidacy further in an interview.

A well-crafted Job Application Letter is your gateway to capturing the attention of potential employers. By following the outlined tips and emphasizing your unique skills and experiences, you can create a compelling and professional cover letter. Remember, this letter is your chance to make a memorable first impression, paving the way for a successful job application process.

Text prompt

• Instructive
• Professional

Generate a job application letter for a college student applying for a tutor position

Write a job application letter for a recent graduate seeking a teaching assistant role in a middle school.

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How to Write an Application Letter

Last Updated: May 6, 2024 Fact Checked

This article was co-authored by Alexander Ruiz, M.Ed. . Alexander Ruiz is an Educational Consultant and the Educational Director of Link Educational Institute, a tutoring business based in Claremont, California that provides customizable educational plans, subject and test prep tutoring, and college application consulting. With over a decade and a half of experience in the education industry, Alexander coaches students to increase their self-awareness and emotional intelligence while achieving skills and the goal of achieving skills and higher education. He holds a BA in Psychology from Florida International University and an MA in Education from Georgia Southern University. There are 7 references cited in this article, which can be found at the bottom of the page. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 179,310 times.

Application letters are typically written to accompany school or job applications. The purpose of the letter is to introduce yourself to the decision committee, and to outline your qualifications in a specific way. It can be the only time other than an interview that you have a chance to really stand out in an application, so it's important to get it right. You can learn what to include in your letter, how to style it, and how to format it to give yourself the best chance.

Application Letter Templates

Writing a Job Application

• A good example would be: "I'm writing to apply for the Chimney Sweep position advertised in Rolling Stone. I think my experience in the heating industry makes me uniquely qualified for this position. Please find my application materials and a brief description of my qualifications below."
• Don't write your name until the signature. It'll be in the header and in the sign-off, so there's no reason to put it in the body of the letter itself.

• Be specific. Who are you? Where do you come from? What's your story? These details are important. HR screeners read hundreds of these.
• Describe your ambitions. Where do you want to go? How will this opportunity help you get there?
• What skills and experiences make you the right fit? Be as specific as possible and avoid vague language. It's better to describe a time you solved a specific problem at your last job than to just write, "I'm a good problem solver at work."

• Tailor it to the business. If you're applying to work at a record store, you need to talk about music. If you're applying to work at a tech company that writes, "Tell us something totally rad about yourself!" it's probably ok to be a little more informal.

• Don't over-promise. Telling someone that you can guarantee that you'll be able to turn around their sales figures in six months or less is a good way to get fired in six months.

• Any kind of job requires this type of research. If you apply to a restaurant, you need to be familiar with the menu and the kind of customers the restaurant attracts. Consider eating there a few times before you apply.
• Don't show you're familiar by criticizing a business and telling them what you can do better. Not the time to offer a harsh criticism of a business plan that you don't really know anything about.

Writing a School Application

• Common prompts include things like, "Outline your qualifications for this position" or "In writing, explain how this position would affect your career goals." Sometimes, the prompt will be as short as, "Tell us something interesting about yourself."
• If there is no prompt, but you still feel the need to introduce your application with a letter, it's usually best to keep it as short as possible. Explain what you're applying for, why you're applying, and thank the contact for their consideration. That's it.

• Often, college prompts will ask you to describe a time you struggled, or a time you overcame some obstacle. Write about something unique, a time that you actually failed and dealt with the consequences.
• The board will get thousands–literally, thousands–of letters about someone's first mission trip, and letters about the time someone's sports team was beaten, then overcame the odds, and won again. Avoid these topics.

• Be specific. If you're writing to a college board, don't say, "I want to go to this college because I need a degree." That's obvious. What do you want to do with it? Why? If you're applying to a business, don't say, "I just need a job." That's obvious. Why this specific job?

• If you're applying to schools, what do you like about the school? What faculty are you interested in? Why this school, instead of another?

Formatting Application Letters

• If you don't get a word-count guideline, just focus on making one or two good points about yourself, and keeping it at that. No need to drone on four several pages.

• Instead of a salutation, write, "Letter of Application" at the top left corner of the page, or put it in the header on the left side at the top.
• If you do have a contact, address it to them, making sure the name is spelled correctly. Then space down and start the body of the letter. [10] X Research source

• Sometimes, it's appropriate to type your name, then print out the letter and sign it in pen. That can be a nice touch.

• Mailing address
• Telephone and/or fax number

Expert Q&A

• Remember to be formal at all times. Do not use abbreviations anywhere. Thanks Helpful 0 Not Helpful 1

You Might Also Like

• ↑ https://www.indeed.com/career-advice/finding-a-job/how-to-write-an-application-letter
• ↑ https://owl.purdue.edu/owl/subject_specific_writing/professional_technical_writing/tone_in_business_writing.html
• ↑ Alexander Ruiz, M.Ed.. Educational Consultant. Expert Interview. 18 June 2020.
• ↑ https://advice.writing.utoronto.ca/types-of-writing/admission-letters/
• ↑ https://wts.indiana.edu/writing-guides/personal-statements-and-application-letters.html
• ↑ https://owl.purdue.edu/owl/job_search_writing/job_search_letters/cover_letters_1_quick_tips/quick_formatting_tips.html
• ↑ https://writing.wisc.edu/handbook/assignments/coverletters/

About This Article

To format an application letter, start by including your name and contact details in the document header. When choosing a greeting, only use one if you know the person's name your writing to. Otherwise, give the document a title, like "Letter of application" at the top of the page. For the body of the letter, aim to write no more than 1 page of single-spaced paragraphs using a standard font. Finally, conclude your letter with a formal greeting like "Sincerely yours." For tips on how to write a job application letter, read on! Did this summary help you? Yes No

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End of Life Decisions for Isolated Patients Under New York's Family Health Care Decisions Act

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The most challenging end-of-life cases involve patients who lack capacity and have no surrogate decision-makers. New York's Family Health Care Decisions Act provides alternative criteria for withdrawing or withholding treatment in such cases, including the requirement that the patient "will die imminently, even if the treatment is provided." This article clarifies the interpretation of "imminent" and offers recommendations to improve end-of-life policies, including greater reliance on Ethics Review Committees (ERCs).

INTRODUCTION

Probably the most distressing end-of-life cases involve patients who lack capacity and who are socially isolated – that is, who do not have a health care agent, family member, or friend who knows them, cares about them, and will make decisions for them. [1] Health care professionals caring for these socially isolated patients struggle with exceedingly difficult professional, ethical, and legal issues. [2] Several states have enacted laws with standards and procedures for such decisions. [3] In New York, the Family Health Care Decisions Act (FHCDA) governs end-of-life decisions for most socially isolated patients. [4] This article examines the provisions for socially isolated patients in the FHCDA. While the FHCDA is just one state’s statute, the clinical, ethical, policy, and even interpretive issues addressed here will be instructive to health care professionals and policymakers in other states as well.

Special attention is given to the FHCDA provision that requires, as a basis for withdrawing or withholding treatment from socially isolated patients, a finding that the patient “will die imminently, even if the treatment is provided.” [5] That critical phrase is a source of uncertainty, both with respect to time period that qualifies as “imminently” and to the application of the phrase to DNR orders. [6] A clear, uniform understanding of the “will die imminently clause” will reduce both undertreatment and overtreatment of socially isolated patients at the end of life.

But an additional policy change is needed. This article recommends that, once standards for ethics review committees are strengthened, the FHCDA should be amended to allow the attending physician to decide to withhold or withdraw life-sustaining treatment for a socially isolated patient based on the standards that now apply to surrogate decisions, subject to approval by an ethics review committee. The FHCDA already allows decisions on this basis for socially isolated patients in hospice; [7] the approach should be broadened.

I.     The Family Health Care Decisions Act

The FHCDA governs decisions for patients in hospitals, nursing homes, and hospices who lack capacity and who did not, prior to losing capacity, make the decision personally or appoint a health care agent. [8] The statute governs consent to treatment and decisions to withdraw or withhold life-sustaining treatment. 

In general, the FHCDA provides for the designation of a surrogate decisionmaker from a priority list.  The highest priority category on that list is a court-appointed guardian when there is one.  After that, the list proceeds through levels of close relatives and ends with the category “close friend.” [9]

     a.     A Surrogate Decision to Withdraw or Withhold Life-Sustaining Treatment

Under the FHCDA, a surrogate may decide to withhold or withdraw life-sustaining treatment from the adult patient who lacks decision-making capacity based on the patient’s wishes, if known or ascertainable through reasonable efforts or when the patient’s wishes are unknown and not reasonably ascertainable, on best interests. Whether the patient’s wishes or the best interest standard is applied, certain clinical ethical standards must be met. For example, either:

(i)   treatment would be an extraordinary burden to the patient and the patient has an illness or injury which can be expected to cause death within six months, whether or not treatment is provided; or the patient is permanently unconscious; or

(ii)   the provision of treatment would involve such pain, suffering, or other burden that it would reasonably be deemed inhumane or extraordinarily burdensome under the circumstances, and the patient has an irreversible or incurable condition. [10]    

This standard, referred to in this article as the “surrogate decision-making standard,” does not require a finding that the patient is imminently dying.    

     b.     FHCDA Provisions Regarding Socially Isolated Patients

FHCDA section 2994-g governs decisions for most incapable adult patients without surrogates. Subsections 5 and 5-a establish the three alternative bases for ordering the withdrawal or withholding of life-sustaining treatment for socially isolated adult patients. As explained further below, life-sustaining treatment can be withdrawn or withheld from a socially isolated patient based on:

          (1) judicial approval;

          (2) the “will die imminently” test; or

          (3) decisions regarding hospice care.

     c.     Judicial Approval

First, the FHCDA allows treatment to be withdrawn or withheld from a socially isolated patient if a court finds that the decision meets the surrogate decision-making standard (terminally ill, permanently unconscious, or extraordinary burden). [11] Prior to the FHCDA, a court had no such authority; it could approve the decision only if it found “clear and convincing evidence” of the patient’s “firm and settled commitment” to forgo treatment under the circumstances. [12]    

     d.     The “Will Die Imminently” Test

Second, treatment can be withdrawn or withheld from the socially isolated patient where:

The attending practitioner, with independent concurrence of a second practitioner, determines to a reasonable degree of medical certainty that:

(i) life-sustaining treatment offers the patient no medical benefit because the patient will die imminently, even if the treatment is provided; and

(ii) the provision of life-sustaining treatment would violate accepted medical standards. [13]  

As noted previously, there is uncertainty among clinicians and others regarding the meaning of “will die imminently” [14] — what does it mean and how long a time period is “imminently”?  Or to use a legal lens: how would the phrase “will die imminently” be construed in an administrative or judicial legal proceeding?  

As explained below, the phrase “imminently” clearly includes a period of hours or a few days, probably includes a week and perhaps two weeks, but probably does not include a month or more.

               i.     Administrative And Judicial Definition

There is no NYS Department of Health regulation or guidance that further defines the phrase “will die imminently.” [15] Such state agency regulation or guidance would have been entitled to considerable deference if a court found that the interpretation required specialized knowledge or expertise. [16]  

Moreover, no published judicial opinion interprets the meaning of “will die imminently” in the FHCDA, so there is no binding precedent. 

The words “imminent” and “imminently” appear in several other New York state statutes.  For example, under New York Mental Hygiene Law, confidential mental health information can be disclosed to an endangered individual based on the practitioner’s determination that the patient presents “a serious and imminent danger” to the endangered individual. [17]    The Family Court Act defines “neglected child” to mean a child “in imminent danger of becoming impaired....” [18] Several courts have interpreted those words for the purpose of those other statutes.  In a child neglect case, the NYS Court of Appeals explained that “’ imminent danger’” must be “near or impending, not merely possible.” [19] However, the interpretation of “imminent” for the purpose of statutes other than the FHCDA is not dispositive of its meaning in the FHCDA.

The phrase "imminent death" is also used in Georgia and Vermont laws as a basis for a DNR order. [20]   But the phrase is not defined in those statutes either.

               ii.     Principles Of Statutory Construction

In the absence of administrative guidance or judicial precedent, a court would define “will die imminently” by using familiar principles of statutory construction. [21] Initially it would look to the plain, customary meaning of the words as well as the statutory context.  If the court needed further guidance, it would consider the legislative history and then possibly professional or scholarly interpretations.  A court would be mindful of policy implications, but it could not twist the plain meaning of the words to achieve policy ends.

               iii.     Plain Meaning

Courts typically start with dictionary definitions “as guideposts to determine a word’s ordinary and commonly understood meaning.” [22] Webster’s International Dictionary, Third Edition (1993) defines “imminent” to mean “Ready to take place; near at hand; impending; hanging threateningly over one’s head; menacingly near.” [23] The Oxford English Dictionary defines “imminent” to mean “Of an event (almost always of evil or danger): Impending threateningly, hanging over one's head ready to befall or overtake one close at hand in its incidence coming on shortly.” [24] Merriam-Webster, a commonly used online reference, defines “imminent” as “ready to take place: happening soon.” [25]

Not surprisingly, none of these definitions specify a time period; the term is intentionally imprecise. It is a qualitative, not quantitative, concept.  But it unmistakably means “soon.” 

               iv.     Statutory Context

Courts will also construe a statute as a whole and consider sections together with reference to each other. [26] In this instance, the statutory context is revealing:  one of the other bases in the FHCDA for a surrogate decision to forgo life-sustaining treatment is that “the patient has an illness or injury which can be expected to cause death within six months....” [27] Accordingly, “imminently” must mean something sooner than “within six months.” The Legislature would not have used different phrases for the same time period.  Put differently, if the Legislature meant “within six months,” it knew how to say it.  It used “imminently” to mean something sooner. [28]

               v.     Legislative History

The legislative history of the phrase “will die imminently” is the most revealing guide to its meaning. The FHCDA was based on the 1992 report and recommendations of the New York State Task Force on Life and the Law, When Others Must Choose – Deciding for Patients Who Lack Capacity . [29] The Task Force recommended two bases for a decision to forgo treatment for socially isolated patient: 

          (1)     A decision by the attending physician to withhold or withdraw life-sustaining treatment, based on the standard that would apply to a surrogate, subject to ethics review committee approval; or 

          (2)     “health care without benefit” is defined as follows:

                    a.     An attending physician determines, in accordance with accepted medical standards and to a reasonable degree of medical certainty, that the patient will die within a short time period despite the provision of treatment and that treatment should be withdrawn or withheld; and

                    b.     one other physician selected by the hospital concurs in this determination. [30]

The Task Force’s proposed clause in paragraph (2), “will die within a short time period,” is the direct forerunner to PHL 2994-g’s “will die imminently” clause. Moreover, as discussed below, the Task Force regarded “a short time period” and “imminently” as having the same meaning.

The Task Force report devotes a full chapter to “Deciding for Adults Without Surrogates,” with a section on “Treatment Without Medical Benefit.” Its discussion in that chapter in support of the “will die within a short period” standard uses all of these phrases for the same concept:

(i) “during the final days and hours of the dying process”

(ii) “the final days of their dying process”

(iii) “at the end stage of their dying process”

(iv) “will die within a short period even if treatment is provided”

(v) “patients who are imminently dying”

Ultimately, the NYS Legislature deleted the first option of allowing a decision for a socially isolated patient based on the surrogate decision-making standard subject to ethics review committee review proposed by the Task Force.  Further below, this article recommends revisiting that option.

More to the point for present purposes, the Legislature modified the Task Force proposed phrase “will die within a short time period” to “will die imminently.”  But neither phrase is quantifiable and, as noted above, the Task Force used them interchangeably.

This article cannot provide an authoritative definition of the precise time period conveyed by the phrase “will die imminently.”  That would need to come from a court, the legislature or a state agency.  But in the absence of such definition, principles of statutory construction indicate that “imminently” clearly includes a time period of hours or a few days, probably includes a week and perhaps two weeks, but probably does not include a month or more.

This conclusion may seem unremarkable.   But it may help counter interpretations at opposite ends of the spectrum.  If “imminently” is read to mean that the patient must be expected to die within minutes or hours for treatment to be withheld or withdrawn, clinicians may feel compelled to provide highly aggressive treatment to the dying socially isolated patient that most would regard as extraordinarily burdensome in light of minimal benefit.  On the other hand, if “imminently” is read to mean that the patient will probably die sometime in the next few months but not the next few weeks, a decision to withhold or withdraw treatment from the socially isolated seems to involve more of a value judgment than a medical judgment.

     d.     DNR Orders

Applying the term “will die imminently” to DNR orders raises special issues. As explained below, the phrase, as applied to a DNR order means that a DNR order can be written based on a finding that in the event of cardiac arrest, the patient will die imminently even if the treatment is provided.   The phrase does not require a finding that the patient is imminently dying at the time the DNR order is written.   

A do-not-resuscitate (DNR) order directs the medical staff not to attempt cardiopulmonary resuscitation if and when, at some point in the future, the patient goes into cardiac arrest. New York’s former DNR law, in effect from 1988 to 2010, created a process and standards for securing surrogate consent to a DNR order. [31] For socially isolated patients, it provided that a DNR order could be entered based on an attending physician and concurring physician determination that resuscitation would be “medically futile.” Per the former statute, “medically futile” means that “cardiopulmonary resuscitation will be unsuccessful in restoring cardiac and respiratory function or that the patient will experience repeated arrest in a short time period before death occurs.” [32]

Significantly, the standard to enter a DNR order for socially isolated patient did not require a finding about the patient’s condition or life-expectancy at the time of writing the order; it just required a finding about whether, in the event of a future cardiac arrest, resuscitation would work.  

The FHCDA was developed to extend the DNR Law to a broader range of life-sustaining treatments. [33] The Task Force and legislature, in proposing the FHCDA, adopted or adapted DNR Law provisions on, among other topics, determining incapacity, a surrogate priority list, clinical predicates to support a surrogate decision to forgo life-sustaining treatment, the patient‘s wishes or best interest standard, and the use of an ethics committee.

With respect to socially isolated patients, the FHCDA could not simply reproduce the DNR Law’s provision on medical futility because the DNR Law provision was treatment-specific: it referred only to the effectiveness of cardiopulmonary resuscitation.  The FHCDA needed to extend the DNR concept of medical futility to encompass decisions about ventilators, feeding tubes, dialysis, antibiotics, and more.  Accordingly, the DNR provision on the futility of resuscitation, extended to other treatments, became in the Task Force’s proposal a finding “that the patient will die within a short time period despite the provision of treatment.” In the final FHCDA, that phrase was changed to a finding that “the patient will die imminently, even if the treatment is provided.”

That background illuminates the meaning of the FHCDA term “will die imminently” as applied to a DNR order:  It means that a DNR order can be written for a socially isolated patient based on a finding that in the event of cardiac arrest, the patient will die imminently, even if the treatment is provided.

The language of the provision supports the above conclusion. “Will die imminently even if the treatment is provided” ties the phrase “will die imminently” to the time the treatment, resuscitation (when the patient has a cardiac arrest), is provided. 

Consider a socially isolated patient dying from cancer that has metastasized. The attending practitioner considering a DNR order may not be able to state with certainty that the patient “will die imminently.”  But the physician may well be able to say with certainty that when the disease finally causes the patient’s heart to stop, the patient “will die imminently, even if the treatment is provided.” 

This is the standard that was in effect under the DNR Law from 1988 to 2010.  Neither the Task Force nor the NYS Legislature intended to disturb that standard in proposing and enacting the FHCDA. As others have noted, “Although the law now uses different words, there are few, if any, cases in this ... category where a DNR order legally could have been issued before FHCDA but could not be issued under FHCDA.” [34]

A NYS Bar Association website, “The Family Health Care Decisions Act Resource Center,” endorses this view. [35]   It includes an FAQ that states as follows:

Health Care Decisions for Adult Patients Without Surrogates. N.Y. PHL § 2994-g) Q – Under the former DNR law, a DNR order could be entered for an incapable patient who did not have a surrogate if the physician and a concurring physician determined that resuscitation would be “medically futile” (if CPR would “be unsuccessful in restoring cardiac and respiratory function or that the patient will experience repeated arrest in a short time period before death occurs”). Can a practitioner still do that? A – The language of the standard has changed, but it still ordinarily supports the entry of a DNR order if resuscitation would be “medically futile” as defined above. Under the FHCDA, the practitioner and a concurring practitioner would need to determine that (i) attempted resuscitation (in the event of arrest) would offer the patient no medical benefit because the patient will die imminently, even if the treatment is provided; and (ii) the attempt would violate accepted medical standards. (Emphasis added).

This NYS Bar Association FAQ, while not an authoritative source of law, was written, reviewed and approved by a broad range of experienced health lawyers and provides strong support for a facility or practitioner that follows this approach.

Moreover, an article by clinicians and bioethicists at the New York City Health + Hospitals, including bioethicist Nancy Dubler, adopted this position as well:

Life-sustaining treatment decisions should be seen as situation-specific, as they depend on the treatment in question and on the medical condition and prognosis of the individual at the time the adverse event occurs, such as cardiopulmonary arrest. Based upon the dismal CPR survival data for nursing home residents with dementia, in the event of cardiac arrest, CPR likely will result in imminent death. [36]

The DNR laws in other states specify this temporal concept.  For instance, a provision in Vermont’s DNR law allows a physician to write a DNR order for any patient (not just isolated patients) upon a certification “that resuscitation would not prevent the imminent death of the patient, should the patient experience cardiopulmonary arrest. . . .” [37]

It would seem that the same conclusion can be reached for a do-not-intubate (DNI) order, a nursing home do-not-hospitalize order, or any other order that directs the withholding or withdrawal or life-sustaining treatment in the event of a future clinical contingency.  Such orders are distinguishable from noncontingent orders meant to be carried out immediately, such as discontinuing a ventilator or feeding tube.  But these treatments may raise different clinical and ethical issues.  In any case, the clearest case, based on words and history, relates to DNR orders.

To be sure, it would have been preferable if the drafters of the FHCDA specified, as Vermont did, that for the purpose of a DNR order, the test is whether, in the event of cardiac arrest, the patient will die imminently, even if the treatment is provided.  And it would be helpful if policymakers clarified this point now. [38] Legislative bills to accomplish this have been introduced repeatedly. [39]   The state Department of Health could also accomplish such clarification by a “Dear CEO/Administrator Letter,” [40] or by revising the MOLST checklist for adults without surrogates. [41] Such clarification would help decrease uncertainty and misunderstanding among health care professionals and their advisers and allow DNR decisions for socially isolated patients based on longstanding, ethically sound principles.

But even without an official pronouncement, the words and history of the “will die imminently” provision make clear what was meant.

As an aside, advances in resuscitative techniques, such as the increased deployment of Extracorporeal Membrane Oxygenation (ECMO), are increasing the duration of patient survival after resuscitation. [42]   ECMO raises complex medical and ethical issues regarding, among other matters, whether a patient is a candidate for the procedure, [43] when to discontinue ECMO after it has commenced, and what a DNR order means as applied to a patient on ECMO. [44] These fraught issues are beyond the scope of this article.  In any case, if and when ECMO becomes a standard of care response to an inpatient cardiac arrest, the FHCDA test for a “do not ECMO order” for a socially isolated patient would seem to be whether, in the event of cardiac arrest, the patient will die imminently even if ECMO is provided. This could lead to a different result than applying the standard to a non-ECMO resuscitation. But this rote application of the FHCDA test would not take into account the exceptionally scarce availability of ECMO equipment and staff, which compels distributive justice considerations, specifically resource allocation, well beyond those raised by CPR. It makes the treatment akin in many ways to decisions about scarce transplantable solid organs, or ventilators in a pandemic. So, there is an ethical argument for devoting ECMO to patients who have a prospect of post-ECMO life.  Again, these are issues beyond the scope of this article.   

     f.    Decisions Regarding Hospice Care

A 2015 amendment to the FHCDA added a third FHCDA basis for withdrawing or withholding treatment from a socially isolated patient. [45] It authorizes the attending practitioner to make “decisions regarding hospice care” for the patient, subject to several oversight requirements. [46] The decision must be made in consultation with staff directly responsible for the patient’s care, with the concurrence of another practitioner, and – significantly — with the review and approval of an ethics review committee. [47]

The FHCDA defines “decisions regarding hospice care” to mean “the decision to enroll or disenroll in hospice, and consent to the hospice plan of care and modifications to that plan.” [48] The reference to “plan of care” signifies that the attending is not simply making the hospice enrollment decision, but the treatment plan as well. The provision requires the practitioner to base his or her decisions regarding hospice care for the socially isolated patient on the principles that would apply to surrogate decisions, including the surrogate decision-making standard for end-of-life decisions. [49] That standard does not require a finding that the patient “will die imminently.”

Data is not available to the extent to which New York hospitals, nursing homes, and practitioners are invoking or even aware of this hospice-related provision as a basis for decisions for socially isolated patients.  But by referring to the surrogate decision-making standard, as opposed to the “will die imminently” standard, the provision gives the practitioner and ethics committee a role akin to that of a joint surrogate for the hospice-eligible socially isolated patient. In fact, it approximates the Task Force’s original proposal, which would have allowed the withdrawal or withholding of life-sustaining treatment from an isolated patient based: a decision by the attending physician applying the standard that would apply to a surrogate, subject to ethics review committee approval. [50]         

II.     Policy Recommendation

This paper proposes to strengthen ethics review committee standards, then allow the attending practitioner to make end-of-life decisions for a socially isolated patient based on the surrogate decision-making standard, subject to ethics review committee approval.    

Clarifying the “will die imminently standard” will improve the quality of care for dying socially isolated patients.  But will not remedy another gap – the need to allow carefully considered end-of-life decisions for socially isolated patients who are not expected to die imminently, but who meet the criteria described in the surrogate decision-making standard (a decision based on the patient’s wishes or, if those are not reasonably known, the patient’s best interests and, summarized, a finding that the patient is terminally ill or permanently unconscious, or the proposed treatment would impose an extraordinary burden on the patient). [51]  

The Task Force’s original 1992 proposal would have addressed this gap by allowing a decision by the attending physician to withhold or withdraw life-sustaining treatment for an isolated patient based on the surrogate decision-making standard, subject to ethics review committee approval. [52] This option would allow for humane, patient-centered, comfort care-oriented end-of-life decisions for socially isolated patients in cases that are not in the “will die imminently” category.  

Moreover, this option dovetails well with the “will die imminently” option: The physician or ERC option addresses cases that include prominent ethical or nonmedical questions. For example, what are this socially isolated patient’s wishes or best interests?  What are the benefits and burdens of the treatment? These questions make it necessary and appropriate to convene an ERC to review and possibly approve a decision.  In contrast, the “will die imminently” basis is primarily a medical question (will the treatment work?). An ERC has no apparent role in that determination unless there is a dispute. [53]

Indeed, allowing the physician or ERC option may reduce concerns about the meaning of “will die imminently” and the reliability of a prognosis that the patient will die imminently. If the attending practitioner is uncertain about whether the patient “will die imminently” but believes comfort care is appropriate for the patient, she or he would be able to refer the recommended course of treatment to the ERC.

Reliance on institutional ethics committee approval for end-of-life decisions for isolated patients is a hardly novel idea. [54] The FHCDA itself already relies upon an ERC to approve the practitioner’s decision about hospice, including a hospice plan of care. [55]  It also makes three other types of end-of-life decisions that are subject to ERC approval. [56] Moreover, some New York hospitals or nursing homes require ERC approval for end-of-life decisions even when applying the “will die imminently” standard. [57]

Elsewhere, some state’s laws recognize a role for ethics committees in decisions for socially isolated patients (Alabama, Arkansas, Georgia, and Tennessee place ethics committees into the priority list of default surrogates) and in other states, hospitals rely upon ethics committees for such decisions without statutory authority. [58]  

There is a strong case in New York for allowing end-of-life decisions for socially isolated patients who do not meet the “imminently dying” criteria based on a practitioner applying the FHCDA’s surrogate decision-making standard, subject to ERC approval.   

III.     Criticism of Reliance on Ethics Review Committees

This proposal will encounter serious substantive criticisms, particularly regarding the role of the ERC. [59]  

The foremost criticism is a concern that, in some cases, the attending physician and ERC may make decisions that undervalue the life of the socially isolated patient who is severely and irreversibly ill but not imminently dying. That risk is even greater for socially isolated patients who face health system discrimination for other reasons: people with physical, mental, or developmental disabilities, poor patients, minority patients, patients with substance abuse-related conditions, prisoners, and very elderly patients.

That concern is very real. But the remedy should not be to compel aggressive treatment in all such cases; that approach fails to consider the particulars of each case and can also cause terrible harm to socially isolated patients. The option of involving a court—apart from the delay and expense—does not really address the concern: it transfers decision-making to a judge who is apt to be inexperienced in these matters and may exhibit the same bias.  

One argument for referring such cases to courts is that courts, unlike ERCs, will apply procedural due process in reaching a decision. [60] Typical due process elements are written notice, hearing, legal representation, right to present evidence, rules about the admissibility of evidence, an impartial decisionmaker, written decision, or appeal rights. But these principles are designed to ensure fairness in adversarial procedures. There is a strong case to apply them when the ERC hears and is empowered to resolve a dispute.  However, the ERC role envisioned here does not involve dispute resolution. It involves reviewing a decision made on behalf of a socially isolated, incapable, non-objecting patient, based on the patient’s wishes, if known, or else the patient’s best interests. This is a part-medical and part-ethical inquiry.  It is emphatically not an adversarial procedure seeking to deprive the patient of rights. 

To be sure, procedural due process is intended to achieve fairness and thoroughness, and some elements of due process would enhance any formal review, including an ERC review. Moreover, if any person connected with the case brings an action to challenge or block an ERC decision, far more processes will be due. The full panoply of judicial-type due process elements should not be grafted onto a physician and ERC’s non-adversarial review of a decision on behalf of the socially isolated patient.   

There is another persuasive argument for caution:  FHCDA ethics review committees have existed in New York since 2010, yet there is little to no information on how well they work in their statutory role. Who is on them?  Do they have significant conflicts of interest?  What are their credentials? Do they have training in the legal and ethical principles they should follow?  How do they collect information about patient wishes and values? Particularly little is known about their current role in approving end-of-life decisions for socially isolated patients in hospice. 

Researchers at Massachusetts General Hospital conducted a retrospective cohort study of ethics committee consultations involving decision-making about life-sustaining treatment for socially isolated patients from 2007 to 2013. [61] They recommended caution before endorsing ethics committees as final decision maker for socially isolated patients. 

Another prominent study surveyed hospitals regarding ethics consultants and ethics consulting. [62] It does not address the role of the ethics committee in making decisions for socially isolated patients. However, some of its inquiries would also be relevant to ethics committees with decision-making authority, including:  Is their financial support adequate? How do they gather information? What records do they keep? How are they evaluated? 

Before expanding the role of ERCs to include end-of-life decisions for socially isolated patients, there is a need for further study. (As of this writing, the Empire State Bioethics Consortium [63] is undertaking just such study.) Depending in part on the findings of a study, consideration must also be given to improving the ERC structure and practices.   For instance, hospitals and ERCs could be encouraged, or even required, to follow model policies regarding: 

(i) Addressing conflicts of interest;

(ii) Addressing bias against patient subpopulations;

(iii) Training in relevant principles of medical ethics and law;

(iv) Procedural steps to follow in end-of-life decision cases, including steps to ascertain patient wishes; Institutional retrospective review of ERC decisions in end-of-life cases (e.g., by the hospital quality assurance committee or other body);

(v) Data collection, subject to QA confidentiality and privilege protections.  

In short, ERCs need to adopt some of the formalities that apply to institutional review boards. [64]   

With additional rules and safeguards, and with increased professionalism of ERCS, end-of-life decisions for socially isolated patients could be based on a physician applying the surrogate decision-making standard, subject to ERC approval.

Additional rules and safeguards, informed by data from studies, will enhance the professionalism of ERCs and the quality of their decision-making. After that step, the FHCDA should be amended to add a fourth basis for an end-of-life socially isolated patient:  a decision by the attending physician based on the surrogate decision-making standard, subject to ERC approval. This would allow for patient-centered end-of-life care for the socially isolated patient. 

New York’s Family Health Care Decisions Act authorizes the withdrawal or withholding of life-sustaining treatment from an incapable, socially isolated patient, among other instances, if the attending practitioner finds that the patient "will die imminently, even if treatment is provided.” That phrase is a source of uncertainty, both with respect to time period that qualifies as “imminent” and to the application of the phrase to DNR orders. This study of the phrase, particularly the legislative history of the phrase, indicates that the term “imminently” clearly includes a time period of hours or a few days, probably includes a week and perhaps two weeks, but probably does not include a month or more.  

Moreover, with respect to DNR orders, a study of the phrase and its legislative history indicates that a DNR order can be written for a socially isolated patient based on a finding that in the event of cardiac arrest, the patient will die imminently even if the treatment is provided. The clause does not require a finding that the patient is imminently dying at the time the DNR order is written. 

Clarifying the “will die imminently standard” will improve the quality of care for dying socially isolated patients, but it will not allow carefully considered end-of-life decisions for socially isolated patients who are not imminently dying, but who meet the criteria described in the surrogate decision-making standard. Policymakers should consider strengthening the standards for ethics review committees to make them more professional. With such changes, the FHCDA should be amended to authorize the attending physician to make an end-of-life decision for an incapable isolated patient based on the same standards that would apply to a surrogate (not the “imminently dying” standard), subject to ERC review and approval. This change will result in more humane, patient-centered end-of-life decisions for socially isolated patients in New York.

[1] N. Karp and E. Wood, Incapacitated and Alone: Health Care Decision-making for Unbefriended Older People. (American Bar Association, Commission on Law and Aging. 2003 Washington, D.C.).

[2] See e.g., H. Kaplan, “Representing Unrepresented Patients,” (Letter from the Editor) AMA Journal of Ethics 21:7:549 (2019) https://journalofethics.ama-assn.org/article/representing-unrepresented-patients/2019-07; T. Dempsey and E.S. DeMartino, “How Should Clinicians Navigate Decision Making for Unrepresented Patients?” AMA Journal of Ethics, Case and Commentary.  21:7:559 (2019); N. Sharadin, “Should Aggregate Patient Preference Data Be Used to Make Decisions on Behalf of Unrepresented Patients?”, AMA Journal of Ethics, Case and Commentary.21:7:566 (2019) https://journalofethics.ama-assn.org/article/should-aggregate-patient-preference-data-be-used-make-decisions-behalf-unrepresented-patients/2019-07; D. Ozar, “Who Are “Unrepresented Patients” And What Counts As “Important” Medical Decisions for Them?” AMA Journal of Ethics, Medicine and Society, 21:7:611 (2019) https://journalofethics.ama-assn.org/article/who-are-unrepresented-patients-and-what-count-important-medical-decisions-them/2019-07; T. Pope, “Five Things Clinicians Should Know When Caring for Unrepresented Patients.” AMA Journal of Ethics 21:7:582 (2019) https://journalofethics.ama-assn.org/article/five-things-clinicians-should-know-when-caring-unrepresented-patients/2019-07.

[3] Meisel, A., K.L. Cerminara and T.M. Pope, Right to Die: The Law of End-of-Life Decision-making (Third Edition 2004.) §8.05; T. Pope, 2017.

[4] N.Y. Public Health Law Art. 29-CC. https://www.nysenate.gov/legislation/laws/PBH/A29-CC The FHCDA does not govern (i) end-of-life decisions for people with developmental disabilities; those are governed by NY Surrogate’s Court Procedure Act §1750-b; or (ii) certain health care decisions for people in mental health hospitals or units, which are governed by Office of Mental Health regulations.  Decisions for isolated patients who have a developmental disability or mental illness can be made by a Surrogate Decision Making Committee (SDMC) established by N.Y. Mental Hygiene Law Article 80.

[5] N.Y. Public Health Law § 2994-g.5(b). https://www.nysenate.gov/legislation/laws/PBH/2994-G

[6] This statement is largely based on my experience as counsel to a health care system, my participation in professional conferences on this issue, and my discussions with clinicians, bioethics professionals, and health care attorneys. But also, compare e.g., Howard J. Finger, James Zisfein, Khoi Luong, Cheryl A. Dury, Ravindra Amin, Steven Hahn, Albina Shkolnik, and Nancy Neveloff Dubler, “Life-Sustaining Treatment Decisions for Unbefriended Nursing Home Resident: Application of a Clinical Ethics Algorithm,” NYSBA Health Law J , Fall 2018 at p.81 https://nysba.org/NYSBA/Publications/Section%20Publications/Health/PastIssues1996present/2018/HealthLawJournal-Fall2018.pdf#page=82 (“imminently” is longer than “immediately” but should be no longer than a few weeks or months”) with Robert S. Olick, K. Faber-Langendoen, “Caring for Patients without Surrogates Under the Family Health Care Decisions Act,” https://www.upstate.edu/bioinbrief/articles/2011/2011-03-case-study-patients-without.php (“likely to die within a matter of days to weeks (not weeks to months)”). With respect to confusion about the application of the FHCDA standard to DNR orders, see Elizabeth Dzeng, Thomas Bein, and J Randall Curtis, “The Role of Policy and Law in Shaping the Ethics and Quality of End-of-life Care in Intensive Care,” Intensive Care Med. 2022 Mar; 48(3): 352-354 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883558/

[7] N.Y. Public Health Law § 2994-g.5-a. https://www.nysenate.gov/legislation/laws/PBH/2994-G

[8] R. Swidler, “New York’s Family Health Care Decisions Act: The Legal and Political Background, Key Provisions and Emerging Issues,” New York State Bar Journal, June 2010.   https://nysba.org/NYSBA/Public%20Resources/Family%20Healthcare%20Decisions%20Act%20Resource%20Center/FHDAC%20Files/SwidlerHealthJournSpr10.pdf Life-sustaining treatment decisions for patients with intellectual or developmental disabilities are governed by separate laws:  the “Health Care Decisions Act for People with Intellectual or Developmental Disabilities” N.Y. Surrogate’s Court Procedure Act § 1750-b and, for isolated patients with mental disabilities, N.Y. Mental Hygiene Law Article 80 Surrogate Decision-making Committees.   

[9] N.Y. Public Health Law §2994-d.1. https://www.nysenate.gov/legislation/laws/PBH/2994-D

[10] N.Y. Public Health Law §2994-d.5. https://www.nysenate.gov/legislation/laws/PBH/2994-D

[11] N.Y. Public Health Law §2994-g.5(a). https://www.nysenate.gov/legislation/laws/PBH/2994-D

[12] Matter of O’Connor (Westchester County Med. Ctr. ), 72 N.Y.2d 517 (1988) https://casetext.com/case/matter-of-oconnor-40; Matter of Storar and Matter of Eichner v Dillon ,  52 N.Y.2d 363 (1981) https://casetext.com/case/matter-of-eichner-fox , https://casetext.com/case/matter-of-storar-2

[13] N.Y. Public Health Law § 2994-g.5(b).  https://www.nysenate.gov/legislation/laws/PBH/2994-G

[14] See note 7 supra. Most of the language in the provision is not problematic. The meaning of “no medical benefit” is clear because the clause itself supplies the definition: it means that “the patient will die imminently, even if the treatment is provided.”  With respect to the requirement that “the provision of life-sustaining treatment would violate accepted medical standards,” if the patient will die imminently, even if the treatment is provided, the treatment has no medical benefit.  Providing a treatment that has no medical benefit is not consistent with accepted medical standards.  American Medical Association Code of Ethics 2024, § 5.5.  https://code-medical-ethics.ama-assn.org/ethics-opinions/medically-ineffective-interventions (Although, despite medical standards, treatment is sometimes provided toward the end-of-life for non-medical reasons, such as acceding to patient or family requests, or to avoid real or perceived legal risk.  See New York State Task Force on Life and the Law 1992, supra note 7, p.169.)

Finally, the requirement that the determination must be made with “a reasonable degree of medical certainty,” employs a phrase that is commonly used in the FHCDA and other New York health laws. E.g., N.Y. PHL § 2994-c (determination of incapacity); N.Y. PHL §2994-d.5 (surrogate decision-making standard).

As an aside, a recent study provides reassurance that clinicians are generally accurate at identifying patients who are expected to die within 60 days and particularly good at identifying patients who are likely to die within 14 days. M. Orlovic, et al., “Accuracy of Clinical Predictions of Prognosis at The End-Of-Life: Evidence from Routinely Collected Data in Urgent Care Records,” 2023, BMC Palliative Care 22:51 (2023) https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-023-01155-y.

[15] The NYS Department of Health approved a Medical Orders for Life-Sustaining Treatment (MOLST) form and posted it on its website.   https://www.health.ny.gov/professionals/patients/patient_rights/molst/ .  That site includes Checklist 4 for “Adult without FHCDA Surrogate.”  But the checklist simply recites the “imminently dying” test without further guidance.

[16] Wang v. James , 40 N.Y.2d 497 (2023). https://law.justia.com/cases/new-york/court-of-appeals/1976/40-n-y-2d-814-0.html A recent decision of the United States Supreme Court struck down the “Chevron Doctrine” whereby courts had been directed to defer to an agency’s interpretation of statutes the agency administers.  Loper Bright Enterprises v. Raimondo, U.S. S.Ct. Slip Op. 22-451 (June 28, 2024.) But that decision does not affect the deference state courts accord to state agency interpretations of state statutes.

[17] N.Y. Mental Hygiene Law §33.13(c)(6) https://www.nysenate.gov/legislation/laws/MHY/33.13

[18] N.Y. Family Court Act § 1012(f)(i). https://www.nysenate.gov/legislation/laws/FCT/A10P1

[19] Nicholson v. Scoppetta , 3 N.Y. 3d 357, 368, (2004). https://www.nycourts.gov/LegacyPDFS/IP/cwcip/Training_Materials/FP_Training/Nicholson_V_Scoppetta-3N.Y.3D357.pdf

[20] O.C.G.A. §31-39-1.1 (Georgia) https://law.justia.com/codes/georgia/title-31/chapter-39/; 18 V.S.A. §9708(d)(3)(B) (Vermont) https://legislature.vermont.gov/statutes/section/18/231/09708.

[21] People v. Williams , 37 N.Y.2d 314 (2021). https://case-law.vlex.com/vid/broughton-v-state-no-887340191

[22] People v. Williams , 2021.

[23] Webster's Third New International Dictionary of The English Language, Unabridged (1993).

[24] Oxford English Dictionary, Second Edition (1989) Oxford, U.K.

[25] Merriam-Webster online .  https://www.merriam-webster.com/dictionary/imminent.

[26] Peyton v. NYC Board of Standards and Appeals , 36 N.Y.3d 271 (2020). https://casetext.com/case/hoffman-v-nyc-bd-of-standards-appeals-in-re-peyton-ex-rel-peyton

[27] N.Y. Public Health Law §2994-d.5(a)(i). https://www.nysenate.gov/legislation/laws/PBH/2994-D

[28] H.G. Finger, C.A. Dury, G.R. Sansone, R.N. Rao, N.N. Dubler.  “An Interdisciplinary Ethics Panel Approach to End-of-Life Decision Making.” Journal of Clinical Ethics . 33:2 (2022).

[29] New York State Task Force on Life and the Law, When Others Must Choose: Deciding for Patients Without Capacity. 1992. Albany, NY.  ISBN: 1881268004. https://purl.nysed.gov/nysl/27683657 .   For a description of the Task Force, its background and reports, see https://en.wikipedia.org/wiki/New_York_State_Task_Force_on_Life_and_the_Law .  I was Staff Counsel to the Task Force from 1985 – 90, and a member of the Task Force from 2011 to the present but was not affiliated with the Task Force at the time it issued this report. I also authored the Wikipedia article cited in this note.

[30] New York State Task Force on Life and the Law, pp. 259-60 (Emphasis added). https://purl.nysed.gov/nysl/27683657

[31] N.Y. Public Health Law Article 29-B, repealed by NY Laws of 2023, Chapter 23. https://www.nysenate.gov/legislation/bills/2023/S8059

[32] Former New York Public Health Law § 2962.12. https://www.nysenate.gov/legislation/laws/PBH/12

[33] New York State Task Force on Life and the Law 1992, Preface and Chapter 12. https://purl.nysed.gov/nysl/27683657

[34] K. Lipson and J. Karmel, “Honoring Patient Preference at The End of Life: The MOLST Process and the Family Health Care Decisions Act,” NYSBA Health Law Journal 16:1 (2011). https://molst.org/wp-content/uploads/2018/11/Lipson.Karmel.HealthLawJournal.MOLST_.2011.pdf .    But see Dzeng, 2022 (the FHCDA standard for DNR futility is being interpreted as narrower than the former DNR Law standard for futility).

[35] New York State Bar Association (2020) Family Health Care Decisions Act Resource Center .  https://nysba.org/fhcda-resource-center.   I was the principal author of the FAQ cited above, but all the FAQs were reviewed and approved by seven other editorial board members.   

[36] Finger, 2022.

[37] 18 V.S.A. § 9708(c)(3)(B) https://legislature.vermont.gov/statutes/section/18/231/09708; O.C.G.A. §31-39-1 et. seq. https://law.justia.com/codes/georgia/title-31/chapter-39/

[38] J.J. Fins, and R.N. Swidler, “A Proposal to Restore Medical Futility as A Clinical Basis for A DNR Order Under New York Law,” NYSBA Health Law Journal 22:1 (2017).

[39] The most recent versions are (NY Senate Bill 2894 (Rivera) (2023) and NY Assembly Bill 7178 (Dinowitz) (2023).

[40] NYS Department of Health – Dear Chief Executive Letters https://www.health.ny.gov/professionals/hospital_administrator/letters/.

[41] https://www.health.ny.gov/professionals/patients/patient_rights/molst/docs/checklist_4.pdf.

[42] H. Ouyang, “The Race to Reinvent CPR,” NY Times , March 27, 2024, NY Times online https://www.nytimes.com/2024/03/27/magazine/ecpr-cardiac-arrest-cpr.html.

[43] I. Wolfe, “On Not Recommending ECMO, Hastings Center Report ,” September-October 2020 https://onlinelibrary.wiley.com/doi/full/10.1002/hast.1177.

[44] E.C. Metzer, N.S. Ivascu and J.J. Fins, “DNR and ECMO: A Paradox Worth Exploring,” Journal of Clinical Ethics 25, note 1 (Spring 2014):13-9 https://pubmed.ncbi.nlm.nih.gov/24779313/.

[45] Chapter 107, New York Laws of 2015, enacting Public Health Law § 2994-g.5-a. https://www.nysenate.gov/legislation/laws/PBH/2994-G

[46] T. Kirk and R. Seigel, “Decisions Regarding Hospice Care for Isolated Patients: A Guide to the 2015 Amendment of The Family Health Care Decisions Act”, NYS Bar Association Health Law Journal 21:3 (2016) https://philpapers.org/rec/KIRDRH; A. Hulkower, G. Garijo-Garde and L. Flicker, “Should Dialysis Be Stopped for An Unrepresented Patient with Metastatic Cancer? American Medical Association Journal of Ethics 21:7, 575 (2019) at 588 https://journalofethics.ama-assn.org/article/should-dialysis-be-stopped-unrepresented-patient-metastatic-cancer/2019-07.

[47] N.Y. Public Health Law § 2994-g.5-a. https://www.nysenate.gov/legislation/laws/PBH/2994-G

[48] N.Y. Public Health Law §2994-a.5-a. https://www.nysenate.gov/legislation/laws/PBH/2994-A

[49] N.Y. Public Health Law §2994-g.5-a. https://www.nysenate.gov/legislation/laws/PBH/2994-G 

[50] New York State Task Force on Life and the Law, https://purl.nysed.gov/nysl/27683657

[51] Under the surrogate decision-making standard, life-sustaining treatment can be withdrawn or withheld when:  (i)  treatment would be an extraordinary burden to the patient and the patient has an illness or injury which can be expected to cause death within six months, whether or not treatment is provided; or the patient is permanently unconscious; or (ii)  the provision of treatment would involve such pain, suffering or other burden that it would reasonably be deemed inhumane or extraordinarily burdensome under the circumstances; and the patient has an irreversible or incurable condition. N.Y. Public Health Law §2994-d.5. https://www.nysenate.gov/legislation/laws/PBH/2994-D

[52] New York State Task Force on Life and the Law, pp 259-60. https://purl.nysed.gov/nysl/27683657

[53]  New York State Task Force on Life and the Law, pp 259-60. https://purl.nysed.gov/nysl/27683657

[54] F. Rosner, “Hospital Medical Ethics Committees: A Review of Their Development,” Journal of the American Medical Association 253(18); (1985) 2693-97.

[55] N.Y. Public Health Law § 2994-g.5-a. https://www.nysenate.gov/legislation/laws/PBH/2994-G

[56] Specifically: in a nursing home, ERC approval is required for a surrogate decision to withdraw or withhold life-sustaining treatment from a patient who is not terminally ill or permanently unconscious (based on extraordinary burden. PHL §2994-d.8(b); In a general hospital, ERC approval is required for the withdrawal or withholding of artificial nutrition and hydration if the attending practitioner objects to such decision by a surrogate. PHL §2994-d.8(c); ERC approval is required for a decision to withdraw or withhold life sustaining treatment from an emancipated minor Public Health Law §2994-3.(3)(a). https://www.nysenate.gov/legislation/laws/PBH/2994-D 

[57] Finger,2022.

[58] Pope, 2019.

[59]     ERCs will also be denounced by some as “death panels.” This article focuses on substantive ethical and policy criticisms but recognizes that there is a volatile political dimension to this as well.      

[60] T. Pope, “The Growing Power and Healthcare Ethics Committees Heightens Due Process Concerns,” Cardozo Journal of Conflict Resolution 15:425 (2014) https://open.mitchellhamline.edu/cgi/viewcontent.cgi?article=1278&context=facsch.

[61] A.M. Courtwright, J. Abrams and E. Robinson. “The Role of a Hospital Ethics Consultation Service in Decision Making for Unrepresented Patients.”  Journal of Bioethics Inquiry 14(2): 241-250 (2017).

[62] Ellen Fox, Marion Danis, Anita J. Tarzian & Christopher C. Duke, “Ethics Consultation in U.S. Hospitals: A National Follow-Up Study, The American Journal of Bioethics, 22:4, 5-18, DOI: 10.1080/15265161.2021.1893547.  https://doi.org/10.1080/15265161.2021.1893547 .  However, while the article describes the prevalence of ethics review committees, it does not address their role as decisionmakers at the end of life.

[63] See http://www.empirestatebioethics.org . The author was a founding member of and a current director of the Empire State Bioethics Consortium, as well as a member of the ESBC team conducting the survey of ethics review committees.

[64] Institutional Review Boards, 21 Code of Federal Regulations Part 56, https://www.ecfr.gov/current/title-21/chapter-I/subchapter-A/part-56.

Robert N. Swidler

MA Binghamton University, JD Columbia Law School, and adjunct faculty at the Alden March Bioethics Center at Albany Medical College. Former General Counsel for St. Peter's Health Partners, past President of the NYS Bar Association Health Law Section, and served on the NYS Task Force on Life and the Law.

The author would like to acknowledge and thank Joseph J. Fins, MD, D Hum Litt, MACP, FRCP and Thaddeus T. Pope, JD, PhD, HEC-C. for their review of an early draft of this article, and their valuable comments.

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