What Are Advance Directives And Why Are They Important?

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While its only human nature to want to avoid thinking about unpleasant subjects, its important to consider what would happen if you became unable to make decisions for yourself due to incapacity or illness.

An advance directive tells your doctor and caregivers what kind of care you would like to receive even if you become unable to make medical decisions. If that should happen to you, making decisions about your medical care will be easier if you've previously identified someone to speak on your behalf and have expressed clear wishes about your care.

These legally binding documents outline your wishes regarding life support, resuscitation and other interventions for both your health care team and family members.

When should I make advance directives?

Some people make advance directives when they are diagnosed with a life-threatening illness; others put their wishes in writing while they are healthy.

How does it help my loved ones?

Too often, when loved ones are left guessing what should be done, the result is guilt, uncertainty and arguments. By making your wishes known, you can help your loved ones feel more comfortable with your choice of care.

What are the types of advance directives?

There are two types of advance directives: a living will and a designation of health care surrogate form, also known as a durable power of attorney for health care. Both forms can be changed at any time, and it's a good idea to update them periodically.

Living will

A living will tells your medical team and your family what treatments you want to receive or refuse, and under which conditions. Your physician and your health care surrogate are required to follow all directives in a living will.

A living will is enacted only when your attending physician and a consulting physician determine that you're: unable to make your own medical decisions and are unlikely to regain this ability; and in a terminal persistent vegetative state, an end-stage condition, or in any other condition that you specified in your living will.

Is a living will the same as a DNR?

No. A Do Not Resuscitate (DNR) order is a separate document stating that you do not wish to be resuscitated in the event of cardiac or respiratory arrest. You must discuss your desire for a DNR with the attending physician so the order can be entered into your medical record. The DNR form has to be completed by you and your physician to be valid.

Designation of health care surrogate

The designation of health care surrogate, also called a durable power of attorney for health care, allows you to appoint someone to make decisions on your behalf when you're unable to do so. It's different than a regular durable power of attorney, which only covers financial matters. Also, its best if you appoint someone who knows your wishes and is willing and able to carry them out, especially regarding your personal, spiritual, moral and cultural beliefs.

In the event that you're incapacitated, your health care surrogate will have the authority to make all medical decisions related to your health care. This includes decisions about when to withhold or withdraw life-prolonging procedures. Designation of health care surrogate takes effect as soon as your physician deems that you're unable to make your own health care decisions. 

Am I required to have an advance directive under Florida law?

No, there's no legal requirement to have an advance directive. However, if you haven't made an advance directive, your health care decisions may be made for you by a court-appointed guardian; your spouse; your adult child; your adult sibling; an adult relative or a close friend. The person making decisions for you may or may not be aware of your wishes. When you make an advance directive, discuss it with your loved ones so they're aware of your wishes.

Getting started

An attorney can be consulted to offer advice on how to tailor advance directives that best meet your wishes. However, even though advance directives are legal documents, an attorney isn't required to write them. The only caveat is you must have two adults witness your directives, and only one of them can be a spouse or blood relative. Also, your designated health care surrogate cannot sign your advance directives.

Where can I find forms?

If you want to write your own, downloadable forms may be found through the Florida Agency for Health Care Administration.

Can I change my mind after I write my advance directive?

Yes, you can change or cancel an advance directive at any time. Your changes should be written, signed and dated. In fact, it's a good idea to review your directives periodically and if changes are made, be sure to provide your primary care doctor with a new copy.

Next steps

Once you've created your advance directives, let members of your immediate family, especially your health care surrogate, know about them and where they're located.

You'll want to share a copy with your primary care doctor to include in your medical records, and remember to provide a new copy if your directives change.

Be sure to also bring a copy of your advance directives with you when you're admitted to the hospital.

Planning for the future is never easy. However, advance directives ensure your wishes are carried out when you're unable to make sound decisions about your health care, and create peace of mind for both yourself and your loved ones. 

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