Advance Directives

"Advance directives” are expressions of treatment preferences provided by patients before they are too sick to communicate. You have the right to accept or refuse care. Advance directives protect this right even when you cannot communicate because of injury or illness. Doctors and other professionals strongly recommend advance directives. There are different types of advance directives. You can have more than one.

• Appointment of a Healthcare Surrogate: By appointing a surrogate, you let others know whom you want to speak for you if you are unable to communicate. You may also appoint someone to speak for you even if you are still able to communicate but would like them to be involved in the healthcare decision-making process on your behalf. Many experts think this is the most important advance directive, because someone you trust will help guide doctors. You should choose someone who knows and understands your preferences, values and views. He or she should make decisions based on what you would say — not what he or she prefers. Appointment of a healthcare surrogate is made by a written document that must be witnessed by two people. Only one of the witnesses may be a spouse or blood relative. The surrogate cannot be a witness.
• Living Will: This is usually a written document that outlines your wishes should you be very ill or dying and unable to communicate. It guides physicians in directing your medical care. If a living will is written, the same rules for witnesses apply.
• Durable Power of Attorney for Healthcare: This is a legal document some patients use to name someone to make healthcare decisions. Some people seek an attorney’s advice when creating a power of attorney document.

Once you complete your forms, give copies to your physician, family and friends who are likely to be contacted in case of a medical emergency.

You can always change or cancel your advance directives. It is important that you review the documents regularly to make sure that they clearly reflect your current thoughts. If something changes, you can complete new forms and notify those responsible for carrying out your healthcare wishes.

If you would like more information on the subject of advance directives, contact:

• The American Geriatrics Society, AmericanGeriatrics.org
• The AGS Foundation for Health in Aging, HealthInAging.org
• American Medical Association, AMA-assn.org
• Caring Connections, CaringInfo.org/StateAdDownload
• Florida Department of Elder Affairs, ElderAffairs.State.Fl.us
• Florida Hospices and Palliative Care, 800-282-6560 or 850-878-2632
• Society of Critical Care Medicine, sccm.org

Advance directives forms are available on the Internet at:

• BaptistHealth.net
• FlSenate.gov
• MyFlorida.com

Advance directives can protect people who are very ill and unable to communicate. They can help give you control over your healthcare. They also relieve loved ones of the burden of guessing what you would want to do. Advance directives are accepted in all 50 states.

Advance directives can limit life-sustaining measures such as:

• Cardiopulmonary Resuscitation (CPR): CPR is used to try to restore a heartbeat. Clinicians use drugs, breathing bags, chest compressions and electric shocks to try to get patients to breathe again or restart their hearts. These attempts often fail. Many patients prefer to die without such interventions.
• Breathing Machine (Respirator or Ventilator): This machine keeps patients breathing by forcing air into their lungs through a tube inserted into the windpipe.
• Intravenous (IV) Line: An IV is a tiny plastic tube inserted into an arm or neck vein to deliver nutrition, fluids and medicine to patients.
• Nutrition Tubes: Such tubes are usually inserted through the nose into the stomach, or surgically inserted directly into the stomach through the skin. They are used when patients cannot eat or drink.
• Kidney Dialysis: Dialysis is the use of a machine to clean the blood when the kidneys are not working properly.

The first step is to discuss your wishes with your family and physician; some people like to consult with clergy or a spiritual adviser. Conversations about end-of-life issues are not easy to have. You might imagine different medical situations and talk about your feelings. Thinking about these difficult circumstances in advance will help protect your rights.

Advance directives forms are available from Baptist Health, on the Internet, from your attorney or from other facilities. The forms may vary in appearance, but all ask you to do the same thing — make decisions about your healthcare.