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I am Loren, a licensed attorney for over 30 yrs. Thank you for your patience as I review the question. I will post my response shortly.
Yes, to avoid confusion and deadlock, only one healthcare agent can be acting at a given time. The healthcare proxy can name an alternate if the primary is not able or is unwilling to serve, but only one person has the authority at a time.
There would always be only one acting agent.
There can be as many layers of alternates as the principal wants, but only one serves at a time.
Welcome to JA and thank you for your question. You can have two people acting as your agent at one time. It is generally preferable to list them in succession in case one is unable to act on the Principal's behalf. http://www.washingtonlawhelp.org/files/C9D2EA3F-0350-D9AF-ACAE-BF37E9BC9FFA/attachments/392A5117-D581-FCE9-5EF2-E382E46B92AC/9608en_powers-of-attorney-and-health-care-directives.pdf
This links sets out the newest information on Health Care Directives https://wsma.org/advance-directives
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