WHAT IS AN ADVANCE DIRECTIVE?
It is a witnessed written or oral statement in which you give instructions about your future medical care, if you become unable to speak for yourself. A designation of a health care surrogate, a living will, or an organ donation document are all advance directives. A durable power of attorney may also be used as an advance directive, if the document includes language about making medical decisions.
WHAT IS A LIVING WILL?
It is a statement which tells your family and physician how you feel about life-prolonging procedures when you are dying or in a permanent coma. The document may be used to request that life-prolonging procedures be provided. However, most often it is used to refuse such measures. You must sign it in the presence of two witnesses, one of whom is not a spouse or a blood relative. There is no requirement in the State of Florida that the document be notarized.
WHY DO YOU NEED A LIVING WILL?
Medical advances can now keep you “alive” when your body has stopped functioning naturally and at the level needed for survival. Under federal and state law as well as the Florida Constitution, you have the right to refuse treatment, whether you are terminally ill or not. A living will gives you the chance to make your medical care wishes known in advance, if you become unable to speak for yourself. The language of the document is important in explaining the medical situations when your decisions would apply.
WHAT ARE “LIFE-PROLONGING PROCEDURES?”
These may include attaching machinery to assist your breathing, performing operations, prescribing antibiotics that may increase your chances of recovery, starting your heart mechanically when it has stopped beating, kidney dialysis or feeding you by tube. You may, if you wish, specifically list in your living will the procedures which you do not want. If you do not include exact instructions, the general directions of your living will should be enough. Remember, specific instructions are preferred. If there is a question about what you meant in the living will, treatment WILL be provided.
WHAT ARE “COMFORT MEASURES”?
Also known as palliative care, these are medication, nursing care and other treatment given for the purpose of keeping you comfortable and free from pain as much as possible. Comfort measures will always continue, even if you have a living will.
IS A LIVING WILL LEGALLY BINDING?
Yes. You have a constitutional right of privacy, meaning you may refuse any treatment at any time, whether you are terminal or nonterminal. Living wills have been given great weight and have been recognized in court decisions as proof of a person’s feelings about these matters. The exact moment when your living will would become effective depends on what medical conditions you have chosen to put in your living will and whether two (2) doctors can agree that you have reached the conditions set out in your living will.
CAN YOU CHOOSE SOMEONE ELSE TO SPEAK FOR YOU IF YOU CANNOT SPEAK FOR YOURSELF?
You may not want to make your own medical decisions, even if you are mentally able to do so. A health care surrogate should then be appointed by you to take on this responsibility.
WHAT IS A HEALTH CARE SURROGATE?
A person designated in writing by you to make health care decisions for you. The document is signed in front of two witnesses, one of whom is not a spouse or a blood relative or the surrogate. There is no requirement in the State of Florida that the document be notarized. The appointment normally becomes effective once two (2) physicians agree in your medical record that you cannot make your own decisions. The surrogate may make decisions for you in matters regarding your health care; discuss your care with health care providers; have access to your medical records; apply for public benefits such as Medicare and Medicaid for you; authorize release of medical records to see that your care continues properly or authorize your transfer to or from a health care facility.
DO YOU NEED BOTH A LIVING WILL AND A HEALTH CARE SURROGATE DOCUMENT?
A living will is the best proof of your wishes because it is signed by you. However, it only covers life-support care. A surrogate has the authority to make health care decisions long before life-support questions come up. It is helpful to your doctors to have someone such as a surrogate, with whom they can discuss your wishes once you are unable to do so, especially if the living will has not yet become effective because of your medical condition. Both documents are suggested. If you want to sign only one, it should be the health care surrogate document.
HOW IS AN ORGAN DONATION FORM AN ADVANCE DIRECTIVE?
It is a way of donating your organs to save another life after you have died. The organ donation law allows for you to make a donation through a donor card, living will, drivers license or some other written form. Having an organ donor card only covers your body after you have died. It does not cover the use of complicated medical equipment, while you are still alive, but in the process of dying. You still need a living will or a health care surrogate.
WHAT IS A DURABLE POWER OF ATTORNEY (DPOA)?
This is a broad document which can cover all aspects of your life, including financial affairs and personal health care. It can be adjusted to your situation with the help of an attorney. Very often, the surrogate’s powers can be included in the durable power of attorney. You may prefer that a surrogate deal only with your medical care and someone else handle your financial matters under a durable power of attorney. The DPOA must be witnessed by two (2) persons AND notarized.
WHAT SHOULD YOU DO WITH YOUR ADVANCE DIRECTIVES?
You should keep a copy with your important personal papers in a safe place known to your family or friends so that they can be easily located. Copies of the documents might also be carried in your wallet clipped to your insurance card. You couId also carry a wallet size card explaining that you have a living will or a health care surrogate or an organ donor card or a durable power of attorney and where these documents can be found. DO NOT place the documents in a safety deposit box, where they cannot be easily located when needed. DO NOT attach them to, or include them in, your Last Will and Testament. You should give a copy of the signed documents to the person who might some day have to show them to your doctors. Give copies to your doctor so they can placed in your medical record. If you do not have a family doctor, you should give copies to several people who are close to you.
ADDITIONAL POINTS TO CONSIDER
In dealing with problems at the end of life, counseling from a religious person can be helpful. Think about involving hospice care toward the end of your life. Hospice helps you and your loved ones deal with the approaching death and provides counseling for the family after your death. Most hospitals and many nursing homes and hospices have ethics committees. These committees can be used in especially difficult situations if the health care team and you, or your agent, cannot agree on how to proceed. If you are a patient or a family member of a patient in a very difficult situation, you may want to talk to the facility’s social worker about involving the ethics committee.