Bitcoin Heart Attack Access

Sudden Incapacity and Delegation Gaps

This memo is published by CustodyStress, an independent Bitcoin custody stress test that produces reference documents for individuals, families, and professionals.

The Suddenness Factor

A person collapses at work. Paramedics arrive. Diagnosis: heart attack. The person is rushed to the hospital. They survive but remain sedated in intensive care. Hours pass, then days. Family gathers at the hospital. Medical decisions get made. Financial obligations continue.

That person held bitcoin. Nobody else knows the PIN to their hardware wallet. The seed phrase sits in a safe deposit box that requires the holder's signature to access. Bitcoin heart attack access becomes a question when the holder cannot respond, cannot sign documents, and cannot provide information while family faces immediate needs.

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The Suddenness Factor

Heart attacks happen without warning. One moment a person is healthy. The next moment they are incapacitated. There is no preparation window. No time to share passwords or write down locations. The person who controlled bitcoin access yesterday cannot provide that access today.

This differs from gradual decline. Progressive illness gives time for conversations. Dementia develops over months or years. Terminal diagnoses create windows for planning. Heart attacks eliminate that window. The holder goes from available to unavailable instantly.

Families discover the access gap immediately. Bills need payment. The spouse tries to access accounts. Bank accounts work through joint ownership. The bitcoin account does not respond to anything the spouse knows. Medical expenses mount. The bitcoin represents significant value. That value sits inaccessible while the holder remains sedated or unconscious.

Days pass. The holder begins recovery. They wake but remain confused. Medications affect cognition. They cannot remember their PIN. Or they remember it wrong. Or they remember multiple PINs and cannot identify which one unlocks the bitcoin wallet. The family waits for full recovery while financial pressures build.

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What Delegation Existed Before the Event

Some holders prepare for incapacity. They share seed phrases with spouses. They write down PINs. They create documented procedures. When heart attack scenarios occur, these preparations activate. The spouse retrieves the documentation. Access continues despite the holder's incapacity.

Other holders intended to prepare but delayed. They planned to share information eventually. The heart attack arrived before eventually did. Or they shared information partially. The spouse knows a hardware wallet exists but not where it is stored. Or they know the location but not the PIN.

Partial delegation creates partial access. A spouse finds the hardware wallet. They try to open it. No PIN works. They call the manufacturer. Manufacturer support explains they cannot provide PINs or seed phrases. The spouse has possession of the device but no way to unlock it.

Some arrangements involve third parties. An attorney holds a sealed envelope containing the seed phrase. The envelope gets opened only upon death or at the holder's written instruction. Incapacity is neither death nor written instruction. The attorney maintains confidentiality. The bitcoin remains inaccessible even though documented delegation exists.

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Hospital Access Attempts

A spouse arrives at the hospital carrying a laptop. They explain to the sedated holder that they need to access the bitcoin. The holder, semi-conscious, nods. The spouse interprets this as permission. They go home and attempt access using information they believe the holder communicated.

The information is incomplete or incorrect. The holder tried to help but could not communicate clearly. Or the spouse misunderstood. Days later, when the holder fully recovers, they learn about the access attempt. They explain the information was wrong. No bitcoin moved. The attempt failed due to communication barriers during incapacity.

Another scenario involves medical privacy. Hospital staff limits visitors. Only certain family members can see the patient. A daughter needs to ask her father about bitcoin access. Hospital rules prevent her from entering his room. She waits for visiting hours. By then, the father is sedated again. The window for communication closes.

Even when communication is possible, accuracy suffers. Pain medication affects memory and speech. The holder tries to explain where the seed phrase is located. They give directions that made sense in their mind but do not correspond to physical reality. The family searches based on these directions and finds nothing.

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Legal Authority During Incapacity

Some states allow emergency powers of attorney. A family member can petition a court for temporary authority during medical incapacity. The court grants authority to make financial decisions. This works for traditional accounts where institutions recognize court documents.

Bitcoin custody does not respond to court documents. A judge grants emergency powers to manage the incapacitated person's assets. The authorized family member presents this document to the bitcoin network. The network processes only valid cryptographic signatures. Court documents do not generate signatures.

The authority-access gap appears again. Legal authority exists. Operational access does not. A spouse has every legal right to manage their incapacitated partner's bitcoin. They lack the cryptographic materials needed to exercise that right. The court document is valid. The bitcoin does not move.

Some families attempt to access bitcoin using legal authority over other assets as justification. They access the holder's email account using court authorization. They search for references to bitcoin passwords or seed phrases. They find partial information. Email shows the holder used a particular exchange but does not show the password or two-factor authentication codes.

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The Time Pressure Dimension

Medical emergencies create urgent financial needs. Hospital stays generate bills. Specialists charge fees. Medications require payment. Insurance may cover portions, but out-of-pocket costs accumulate quickly. Families face pressure to access funds while the holder recovers.

Bitcoin represents a large portion of the family's liquid assets. Other accounts hold smaller amounts. The family can cover days or weeks of expenses from those accounts. The bitcoin could cover months. Access to that bitcoin would relieve financial stress. The inability to access it compounds existing stress from the medical emergency.

Time pressure affects decision-making. A spouse considers guessing PINs despite knowing this might lock the device permanently after too many wrong attempts. They weigh the risk of losing access entirely against the need to access funds now. Desperation grows as medical bills arrive and bank balances decline.

Recovery timelines are uncertain. Doctors cannot predict when the holder will regain full cognitive function. Some heart attack patients recover quickly. Others face months of rehabilitation. Families cannot plan around a specific date when the holder will be able to provide access information. They operate in indefinite uncertainty.

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The Hardware Wallet in the Hospital Safe

A holder carried their hardware wallet in their pocket. After the heart attack, hospital staff inventories personal items. The wallet, phone, and keys go into the hospital safe. Family members can retrieve these items with proper identification and authorization.

The spouse retrieves the items. They now have the hardware wallet. They take it home. They attempt to access it. Multiple PINs fail. The device still has attempts remaining but the spouse stops, afraid of triggering a permanent lockout. They have the device but still no access.

Weeks later, the holder recovers enough to communicate. The spouse brings the hardware wallet to the hospital. The holder tries to enter the PIN. Hands shake from medication or weakness. They enter it wrong twice. On the third attempt, they enter it correctly. The device unlocks. But the holder cannot complete a transaction from the hospital bed. They need their phone for authentication codes, or they need to be at their home computer, or they need something else they do not have access to while hospitalized.

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When the Holder Does Not Recover

Some heart attacks prove fatal despite medical intervention. The holder dies in the hospital. What began as bitcoin heart attack access becomes an inheritance scenario. The family transitions from seeking temporary access during incapacity to seeking permanent access as heirs.

The delegation that did not exist during the emergency still does not exist after death. The spouse who could not access bitcoin while the holder was sedated still cannot access it after the holder dies. Emergency authority ends. Estate authority begins. Neither authority produces the seed phrase or PIN.

Estate processes take months. Probate courts assign authority to executors. Executors locate assets. Bitcoin becomes an asset the executor knows exists but cannot reach. Legal authority has been established through probate. Operational access remains absent. The transition from medical emergency to estate administration changes the legal framework but not the access reality.

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Family Knowledge Gaps

A spouse knows their partner holds bitcoin but does not know custody details. They never discussed wallet types, storage locations, or backup procedures. The heart attack exposes this knowledge gap when access becomes necessary.

The spouse searches the home. They find a USB drive. Is this a hardware wallet? Is it a backup? Is it something else? They have no technical background to interpret what they find. They call a friend who knows about bitcoin. The friend looks at the device. It is a hardware wallet. But without the PIN, the friend cannot help further.

Another family member remembers a conversation about "cold storage." They do not know what this means. They search online. Cold storage can mean hardware wallets, paper wallets, air-gapped computers, or other methods. Each requires different access procedures. The family does not know which method their incapacitated relative used.

Technical knowledge gaps compound access gaps. Even when families locate custody materials, they may not recognize them. A seed phrase looks like random words. A family member finds a list of words in a drawer. They assume it is a poem or language practice. They do not recognize it as a bitcoin recovery phrase. The access materials are in their hands. They remain invisible due to knowledge gaps.

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The Prepared Arrangement That Failed Under Stress

A holder created a documented bitcoin access procedure. They wrote instructions. They stored copies with their attorney and their spouse. The document explains where the hardware wallet is kept, where the seed phrase is stored, and what steps to follow for recovery.

Heart attack occurs. The spouse retrieves the documentation. Step one: locate the hardware wallet in the home office desk. The spouse searches. The wallet is not there. The holder moved it months ago to a safer location and did not update the documentation. The written procedure is now inaccurate.

Or the documentation is accurate, but complex. It references multiple locations and materials. The spouse follows the steps but encounters technical terms they do not understand. "Derive the wallet using BIP39." The spouse does not know what BIP39 means or how to derive anything. The documentation assumed technical knowledge the spouse does not have.

Some prepared arrangements depend on the holder being available for clarification. The instructions say "contact me if any step is unclear." A heart attack removes that option. The spouse faces unclear instructions with no one to ask. They make their best interpretation. It is incorrect. The access attempt fails despite preparation existing.

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Multi-Party Coordination Failures

A holder used a multisignature wallet requiring two of three signatures. They held one key. Their brother held another. A custody service held the third. The arrangement protected against single points of failure. It also created coordination requirements.

Heart attack incapacitates the holder. Their spouse wants to access bitcoin to pay medical bills. They contact the brother. The brother is traveling overseas with limited phone access. They contact the custody service. The service requires written authorization from the account holder to release their signature. The account holder cannot provide written authorization while sedated.

Days pass. The brother returns and can provide his signature. The custody service still requires holder authorization. The spouse obtains emergency legal authority and presents it to the custody service. The service reviews the document with their legal team. This takes additional days. Eventually, access is granted. The coordination delay lasted two weeks while medical bills accumulated.

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Conclusion

Bitcoin heart attack access exposes the gap between delegation planning and sudden-onset incapacity. Heart attacks eliminate preparation windows. Holders go from available to unavailable instantly. Families face immediate access needs while the holder cannot communicate, cannot sign documents, and cannot provide passwords or locations.

Delegation that exists on paper may fail under stress due to outdated information, technical complexity, or coordination requirements. Legal authority granted through emergency powers does not translate to operational access. The bitcoin network requires cryptographic materials, not court documents.

Time pressure compounds the access gap. Medical expenses accumulate. Families cannot wait for full recovery before addressing financial needs. The holder who intended to share access information never had the chance. What was planned for eventual implementation becomes necessary immediately. Understanding these dynamics explains why sudden medical emergencies create bitcoin custody failures despite good intentions.

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System Context

Examining Bitcoin Custody Under Stress

Can My Family Access My Bitcoin If I Die

Bitcoin Custody for Non-Technical Spouse

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