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Advanced Directives

What Is An Advance Directive?
Advance directives are witnessed written documents or oral statements in which you give your choices for health care or appoint someone to make decisions for you if you become unable to make those decisions. Advance directives can help ensure your wishes will be carried out, even if you are unconscious or cannot make your preferences known. There are three types of Advance Directives: Living Will; Health Care Surrogate Designation; and Anatomical Donation.

Why Are Advance Directives Important?
Many people want to make sure their preferences for end-of-life care are met -- even if they cannot speak for themselves. Some people want to refuse aggressive medical treatment if there is no reasonable chance of recovery. Others want to avoid extending or worsening their discomfort or suffering “by machines.” Still others see news reports about dramatic cases and want to prevent disagreement over the preferences of different family members. It is never too early to start this decision-making process, and you should not postpone it until you face serious illness. If you choose someone to make decisions for you, be sure to discuss details of your advance-care preferences. It is important for your surrogate to know your values and desires regarding treatment. For instance, if you were dying and would not want aggressive medical treatment, you should make sure your surrogate is aware of this decision. Surrogates have the duty to do what you want -- not what they prefer or are more comfortable with.

What Does The Law Say?
Florida law, 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.” Advance directives are one way to make sure this right is respected. 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 Living Will?
The living will is a document you can prepare which outlines your care preferences if you become incapable of making medical decisions and suffer from an end-stage condition, a terminal condition or are in a persistent vegetative state. In a living will you can:

  • Indicate a person to carry out your wishes.
  • State what types of life-prolonging procedures you would want or not want, including circumstances under which you would choose these procedures or have them, withheld or withdrawn.
  • Discuss other issues which 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. You should 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 wish to discuss it with a lawyer.

What Is An Anatomical Donation?
It is a document that indicates your wish to donate all or part 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 Resucitate Order (DNRO)?
This order 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.

What Is A Health Care Surrogate?
Florida law encourages the designation of a “health care surrogate” to make decisions for patients in the event they are unable to do so themselves. Surrogates provide consent for treatment --- or express the patient’s right to refuse unwanted treatment. A surrogate can be a family member or friend.

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. A durable power of attorney for health care should be prepared with the help of competent legal counsel.

What If I Draw Up An Advance Directive And Then Change My Mind?
You may change or revoke your advance directive at any time. You can do this by just saying so. You also may do it in writing, or by simply destroying any existing documents and notifying others who have copies that your advance directive has been revoked. It is your responsibility to notify others of this. 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, and others who might need to know. If you consulted an attorney in drawing up your document, you also should notify him or her. You also 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 a new one is executed or if your attending physician and another physician agree you have retained your ability to make decisions. Finally, if you chose your spouse as your health care surrogate and were 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 Am Hospitalized In Another State?
Most states --- including Florida --- have laws requiring that advance directives from other states be honored. 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 Execute 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 that while the law accepts a “witnessed oral statement” as an advance directive, many experts recommend a written, signed document.

How Can I Know In Advance Which Procedures I Would Want To Prolong My Life?
Your preferences about life-prolonging care can become clearer by thinking about them and discussing them with your family, friends, and others. What are your views about death? About being totally dependent on care provided by others? Are there conditions that would make life not worth living? Should artificial life-support be used? For how long? You should feel free to discuss any of these questions with your doctor and other members of your Sylvester health care team.

What Happens If I Don’t Have An Advance Directive?
If you do not have a living will or have not appointed a health care surrogate, and a physician has determined that you lack the capacity to make health care decisions, the law requires that a Health Care Proxy must appointed in an order of priority which includes legal guardian, spouse, adult child, parent, adult siblings, adult relatives and a close friend. Treatment decisions are greatly 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 end-of-life care.

Are There Restrictions On The Types Of Decisions My Surrogate Can Make For Me?
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, and voluntary admission to a mental health facility. Also, the law allows you to place any additional restrictions on your surrogate’s authority that you desire. This includes your ability to restrict your surrogate’s authority to consent to the withholding or withdrawal of life-prolonging procedures.

Do I Have To Execute An Advance Directive?
No. It is entirely up to you. 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 It Is Executed?
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. You also might 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 telephone number of your surrogate. Surrogates should have copies of your advance directive.

Where Do I Go If I Want To Learn More?
You should always feel free to 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 1-888-419-3456 or write:

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

The agency also has a website with more information about advance directives. Visit https://www.tmh.org. Another useful document about end-of-life care is available via the Florida Department of Elder Affairs at http://elderaffairs.state.fl.us.

If you have any concerns or complaints regarding non-compliance with advance directive requirements, call the Agency for Health Care Administration at 888-419-3456 or visit www.floridahealthfinder.gov.