Advance Directives

What Are Advance Directives?

“Advance Directives” are legal documents that allow you to plan and make your own end‑of‑life wishes known in the event that you are unable to communicate due to incapacity or illness. These legally binding documents outline your wishes regarding life support, resuscitation and other interventions for both your health care team and your family members.

About Advance Directives

There are two different types of Advance Directives: A Living Will and a Designation of Health Care Surrogate Form, which is sometimes known as a Durable Power of Attorney for Health Care or Medical Power of Attorney. Both can be changed anytime, and you’ll want to update them periodically.

What is a Living Will? A living will is an advance directive that guides your family and healthcare team through the medical treatment you wish to receive if you are unable to communicate your wishes. According to your state’s living will law, this document is considered legal as soon as you sign it and a witness signs it, if that’s required. A living will goes into effect when you are no longer able to make your own decisions.

What is a Designation of Healthcare Surrogate? A medical power of attorney is the advance directive that allows you to select a person you trust to make decisions about your medical care if you are temporarily or permanently unable to communicate and make decisions for yourself. This includes not only decisions at the end of your life, but also in other medical situations. This document goes into effect when your physician declares that you are unable to make your own medical decisions. The person you select can also be known as a healthcare agent, surrogate, attorney‑in‑fact or healthcare proxy.

If you establish Advance Directives, make sure members of your immediate family know about them and where they are located. You’ll also want to share a copy with your primary care physician to include as part of your medical records, and them provide a new copy if your directives change. Be sure to also bring a copy with you when you’re admitted to the hospital.

FAQs About Advance Directives

On What Laws are Advance Directives Based? Two main statutes guide the Advance Directives. At the federal level there is the Patient Self-Determination Act. In addition, each state has laws that provide for Advance Directives. For example, Florida’s Health Care Advance Directive Act (Florida Statute Chapter 765) outlines its guidelines for Advance Directives.

Why is it Important for Me to Complete Advance Directives? There may be times whether because of an accident, injury or illness, you may not be able to make sound decisions about your health care. However, decisions still need to be made regarding your treatment and care; directives outline who can legally speak on your behalf and see that your wishes are carried out.

Who Can Complete an Advance Directive? Any person who is 18-years of age and older, as well an emancipated minor, can have Advance Directives.

When is an Advance Directive Valid? Requirements for notarization and witnesses you need present when you sign your Advance Directives may vary by state law. In Florida, only one can be a spouse, family member or relative; your health care surrogate cannot be a witness. In Florida, these documents do not need to be notarized to be legal, though some prefer to have them notarized along with any other legal documents, such as a will.

When do Advance Directives Take Effect in a Hospital? The Designation of Health Care Surrogate takes effect as soon as your physician deems that you are unable to make your own health care decisions. A Living Will will be enacted only when your attending physician along with a consulting physician determine you are:

1. Unable to make your own medical decisions and are unlikely to regain this ability.
   
   AND


2. In a terminal persistent vegetative state, an end-stage condition, or in any other condition that you specified in your Living Will. A more complete definition of applicable conditions can be found in the instructions section of the Advance Directives form available for download above.

How Long are Advance Directives Valid? This may vary by state law. In Florida, these documents are valid indefinitely, unless you have specified an expiration date on the document. They become void at the time of your death or when you have rescinded them or declared them void.

Who Would make the Decisions on My Behalf if I Did Not Have an Advance Directive? This may vary by state law. If you are unable to make decisions, healthcare professionals must consult your family members. Some states have decisions‑making laws to identify individuals who may make decisions on your behalf when you do not have an Advance Directive, such as your spouse, parents or adult children.

According to Florida law, the following individuals would make these decisions. They are, in the order of priority:

1. Spouse (Florida law does not recognize common law marriages as a legal marriage contract).
2. Adult children who are reasonably available for consultation (in person or by phone).
3. Parent(s).
4. Sibling(s) who are reasonably available for consultation (in person or by phone). Being the oldest child does not give that child any higher priority.
5. Relative who has exhibited special care and concern for the patient and who has maintained regular contact with the patient and who is familiar with the patient's activities, health and religious or moral beliefs.
6. Close Personal Friend - to qualify, the friend shall be 18 years of age or older, have exhibited special care and concern for the patient; has signed a Close Personal Friend affidavit stating he or she is a friend of the patient; and is willing and able to become involved in the patient's healthcare and has maintained regular contact with the patient so as to be familiar with the patient's activities, health and religious or moral beliefs.

When Should a Person Make sure that a Designated Health Care Surrogate has Been Appointed? Prior to your medical procedure you should appoint a designated health care surrogate. If you already have one designated, changes in marital status or within your family may require changes to your surrogate appointment as well:

• Single
• Newly Married
• Divorced, or contemplating divorce
• Separated
• Living with a significant other
• Wanting to designate one person from the proxy category where there are several people.

When I am Admitted as a Patient to an AdventHealth Hospital, will I be Asked About Advance Directives? Yes, if you are an adult or emancipated minor inpatient. When you are admitted to a nursing unit you will be asked to complete a personal health history form or your nurse will assist you. At this time you will be asked about an Advance Directives form that has a summary of AdventHealth’s policy.

If you have completed Advance Directives, please bring a copy with you to the hospital and give it to your nurse. If you would like to complete one, please let your nurse know. If you have questions after reading the instructions on the back of the Advance Directives form, you may request to speak to a chaplain, case manager or your physician.

Does a Living Will Mean the Person is not to be Resuscitated in the Event of a Cardiac and/or Respiratory Arrest? No, but if you do not wish to be resuscitated in the event of cardiac or respiratory arrest, you must discuss this with the attending physician so that a Do Not Resuscitate (DNR) order can be entered into your medical records. This form must be completed by you and your physician in order to be valid and take effect.