What is an advance directive?

If you are unable to communicate your health care choices, an advance directive will communicate on your behalf. They are witnessed written documents or oral statements in which you list your health decisions or appoint someone to make your intentions known for you.

There are three types of advance directives:

• A health care surrogate designation
• A living will
• An anatomical donation

Why is advanced care planning a good idea?

People want to make sure their preferences for critical or end-of-life care are met if they cannot speak for themselves. Some choose to create an advanced directive to:

• refuse aggressive medical treatment if there is not a reasonable chance they will recover
• avoid extending or worsening any discomfort or suffering on "machines”
• prevent disagreements between family members over their care decisions

Don't wait to get an advanced directive until you face a serious illness. If you choose someone to make decisions for you, make sure they know your values and desires.

What does the state and federal law say?

Florida law, specifically Chapter 765 of Florida Statues, encourages patients to complete advance directives, saying that, “every competent adult has the fundamental right of self-determination regarding decisions pertaining to his or her own health, including the right to choose or refuse medical treatment.”

In 1990, the U.S. Congress passed the Patient Self-Determination Act. This federal law requires hospitals to inform patients about advance directives.

What is a health care surrogate?

Surrogates provide consent or express the patient’s right to refuse treatment. A surrogate can be a family member or friend.

• Designation of Healthcare Surrogate and Living Will - English
• Designación de sustituto para decisiones médicas y testamento vital - Spanish
• Deziyasyon Ranplasan Swen Sante ak testaman vivan - Creole

Are there restrictions on the decisions my surrogate can make?

There are certain types of decisions that your surrogate can make only if you have specifically authorized them. These include:

• abortion
• sterilization
• electroconvulsive therapy
• psychosurgery
• certain experimental treatments
• voluntary admission to a mental health facility

Also, the law allows you to place any additional restrictions on your surrogate’s authority that you want. This includes your ability to restrict your surrogate’s authority to consent to the withholding or withdrawal of life-prolonging procedures.

What is a living will?

A living will is a document which outlines your care preferences in case you become incapable of making medical decisions and suffer from an end-stage condition, a terminal condition, or are in a persistent vegetative state. With a living will, you can:

• Indicate a surrogate, a person to carry out your wishes.
• Make clear the types of life-prolonging procedures you would want or not want. This includes circumstances under which you would choose these procedures or have them withheld or withdrawn.
• Discuss other issues that may be important to you; for example, the role your religious preferences will play in end-of-life decisions.

A written living will should be signed, dated, and witnessed by two people. At least one of the witnesses must be someone who is not your spouse or relative. Discuss your wishes with your family and your physician. Your living will becomes a part of your permanent medical record. Although you do not need a lawyer to draw up a living will, you may want to inform your legal representative.

What is a durable power of attorney for health care?

Some patients like to execute formal legal documents that give decision-making authority to a particular person. This is usually the same person you would want to be your surrogate. We advise that you prepare this with the help of competent legal counsel.

What is an anatomical donation?

This is a document that indicates your wish to donate part or all of your body. This can either be an organ or tissue donation to a person in need or donation of your body for training of health care workers.

You can indicate your wish to be a “donor” on your state identification card or driver’s license.

What is a Do Not Resuscitate Order (DNRO)?

The DNRO identifies a person who does not wish to be resuscitated from respiratory or cardiac arrest. It is a yellow form from the Florida Department of Health.

If you would like to have this form, have a conversation with your doctor on your next visit for more information.

What if I draw up an advance directive but change my mind?

Rest assured, you may change or revoke your advance directive at any time. How? Just say so. You also may do it in writing, or by destroying your existing documents. But remember, these directives are created to clear up confusion. Always notify people who have copies that you have changed the advance directive. The copy in the medical record cannot be destroyed but can be revoked.

If you wish to cancel an advance directive while you are hospitalized, you should notify:

• Your primary physician
• Your family
• Others who might need to know
• Any attorney you consulted in drawing up your document

You may change your designation as a donor in your Florida identification by contacting your nearest driver’s license office.

An advance directive also is revoked if you create a new one or if your attending physician and another physician agree you have retained your ability to make decisions.

Finally, if you choose your spouse as your health care surrogate and then become divorced, he or she would not remain your surrogate unless you direct that the designation should continue after divorce.

What if I fill out an advance directive in one state but become hospitalized in different state?

Most states — including Florida — have laws that honor advance directives from other states. If your wishes are clear, they should be followed in any state.

In fact, if you don’t have an advance directive, it might be more difficult to have your wishes carried out in an unfamiliar location.

Where can I get an advance directive?

Forms are available in the admitting office, or you may request them from your physician, nurse, or social worker. You may use our forms and select the choices you wish. You may change any of the words and add any further instructions. Or you may bring us your own forms, and they will be made part of your medical record.

Florida law does not require any special advance directive forms. However, the statement needs to be witnessed by two individuals. At least one witness cannot be a spouse or blood relative.

Note: while the law accepts a “witnessed oral statement” as an advance directive, many experts recommend a written, signed document.

How can I know which procedures I would want to prolong my life?

Ask yourself questions like the following, and then discuss them with your family, friends, or others.

• What are my views about death?
• Do I want to be totally dependent on care provided by others?
• Are there conditions that would make life not worth living?
• Should artificial life-support be used for my care? For how long?

Feel free to discuss any of these questions with your doctor and other members of your health care team.

What happens if I don’t have an advance directive?

The law requires that a Health Care Proxy be appointed if:

• you do not have a living will
• have not appointed a health care surrogate
• a doctor has determined that you lack the capacity to make health care decisions

The order of priority for this appointment is legal guardian, spouse, adult child, parent, adult siblings, adult relatives, and a close friend.

Treatment decisions are complicated when there is no surrogate, and when no proxy can be found. If you do not have a living will, it might be difficult to know your preferences for critical or end-of-life care.

Do I have to have an advance directive?

No. The law requires only that you be given written information regarding your right to execute an advance directive if you wish to do so.

What should I do with my advance directive once I have it?

Once you have an advance directive, you should inform your physician as well as your family, friends, or attorney so that it can be found if needed. Copies should be easily accessible to those who need them.

Consider keeping a small card in your wallet or purse stating that you have an advance directive, where it is located, and the name and phone number of your surrogate. Your surrogate should have a copy of your advance directive. Learn more.

Talk to your doctor, nurse, or social worker about advance directives. If you have any concerns or complaints regarding non-compliance with advance directive requirements, call the Agency for Health Care Administration at 1-888-419-3456, visit FloridaHealthFinder.gov or write to:

Consumer Assistance Unity
Agency for Health Care Administration
2727 Mahan Drive • Fort Knox Building, Room 339
Tallahassee, Florida 32303

Learn more via the Florida Department of Elder Affairs. Visit: ElderAffairs.State.Fl.us.