When should I prepare my advance directive?
The best time to prepare your advance directive is when you are healthy and not anticipating a health crisis. This allows you the time to make preparing the advance directive a thoughtful process.
When you read further you will be aware of what is involved in preparing and making your advance directive effective.
Do I need help preparing my advance directive?
Florida law does not require you to have the assistance of anyone in preparing your advance directive. However, as you read through this information, you will see that it is advisable to speak with several different persons as you prepare, particularly your immediate family members.
Some persons may want to consult with their attorney, but it is not required by law.
You may choose either of these alternatives. Regardless, you will have to go through a thoughtful process in order to know what your preferences are and be able to communicate them to your family. There is no one form or type of advance directive that is universally accepted as the correct one.
If you are preparing your advance directive at a time when you are healthy, we encourage you to consider using a "Health Care Surrogate" type of advance directive, whether you are writing your own or using an existing form. It has the advantage of allowing you to name a specific person who will be your decision maker. And, it pertains to any illness when you are incapacitated and health care decisions must be made for you, not just end-of-life issues. If this type of advance directive is your choice, then our section on information about advance directive will be particularly helpful to you.
Our section on examples of advance directive used by Shands provides copies of the two types of advance directives that Shands makes available to patients/families. You may find them useful if you do not want to write your advance directive completely. In Section O several examples of forms are available online. It might be helpful to review each.
Advance directives are made up of two basic parts. One part provides instructions to your physician and to your family. The other component identifies someone to make medical treatment decisions for you in the event that you cannot speak for yourself. We recommend that your advance directive include both of these parts. Examples are presented below.
Examples of "instructions" that may be included in your advance directive
- End-of Life-Information: Think about what quality of life would be acceptable to you when you are approaching death. If you could still speak with and be aware of your loved ones, would you want medical assistance to continue? What if you could no longer be aware that your loved ones were present, would you want to continue life under those circumstances? Other specific information you might include would be whether you want food and water provided through a tube and, if so, under what conditions. Do you want to be pain free with the provision of comfort care, even if pain medication were to reduce your alertness or awareness?
- Do Not Resuscitate and/or Do Not Intubate information: These treatments also pertain to end-of-life, but need to be addressed independently from the previous decisions. If you are dying, and either your heart stops beating or you stop breathing, your physician is obligated to resuscitate you unless you have indicated you don't want either chest compressions and/or a tube placed down your throat. Requesting DNR and/or DNI in your directive informs your physician that you do not wish to be given CPR or other emergency treatments if your heart stops beating or you stop breathing.
- If you have a long term or progressive illness, you should consult your health care provider for information concerning the likely success of resuscitation efforts.
- Organ/Tissue Donation information: After you die, if you wish to donate any organs, tissues, skin, bone, etc., that may be useful in the treatment of other persons, then you would include these instructions in your advance directive.
Examples of "identifying" who will be your decision maker if you are incapacitated:
A "proxy"decision maker - If you do not have a specific person you wish to be your decision maker, then you need only provide instructional information in your advance directive. When you are not able to communicate and have not named a specific person, your physician will use a list provided by the State of Florida (765.401) to determine who will make decisions for you.
In order of priority, the list is:
- The judicially appointed guardian or guardian advocate of the patient
- The patient's spouse
- The adult child or adult children who are reasonably available
- A parent of the patient
- The adult sibling or adult siblings of the patient who are reasonably available
- An adult relative of the patient who cares and has regular contact
- A close friend of the patient
- A clinical social worker approved for the decision maker role
The disadvantage of this approach is that the first person on the proxy list may not know what your preferences are or may not agree with these preferences. He or she may not feel comfortable serving as your decision maker.
A Surrogate decision maker - You may name a specific person to be your decision maker - the person who will express your wishes. This person is called a surrogate. The advantage of this approach is that you can name someone you are confident understands and will represent your preferences for treatment when you cannot speak for yourself.
In Florida law, a surrogate is presumed to know the patient's wishes, more so even than the proxy. So, if you are married and you are comfortable with your spouse being your proxy, it would be wise to formally appoint him/her as your surrogate.
How do I make my advance directive most effective?
There are several things you can do. But, they all begin with understanding the information we are providing you. Here are the things you can do to make your advance directive most effective.
- Meet with your family and/or significant others to give them a copy of your advance directive. During this meeting, let them discuss among themselves and with you any concerns they may have. The purpose of this meeting is for them to learn about your wishes/preferences.
- Give a copy of your advance directive to other persons outside your family who are important to you, such as your physician, attorney, minister, etc.
- Every 4-5 years, re-sign your advance directive and initial a new date. This gives assurance that your wishes have not changed over the years.
- Whenever you go to your physician or are admitted to a hospital, take a copy of your advance directive and ask that it be placed in your medical record.
Once you have completed your advance directive, it does not go into effect until several things occur. First, you must not be able to speak for yourself, including writing or making signs that are understandable. Second, if your advance directive addresses end-of-life issues, as in a living will form of advance directive, then your physician must have diagnosed you with a terminal illness, an end-stage condition, or as being in a permanent vegetative state.
If you have a Health Care Surrogate form of advance directive, it goes into effect when you are unable to communicate.
When you are able to speak with a clear mind, even if you are dying and/or have an advance directive, your physician should talk with you about your treatment preferences and not turn to your advance directive for directions until you are incapacitated.