Thinking Ahead

How creating an advanced directive brings peace of mind to life’s most difficult time.

You’re healthy. You’re young. You’re busy. You don’t want to think about dying.

All of those are common excuses for putting off one important step: making a living will.

Also referred to as an “advance directive” because it outlines your wishes in advance, a living will specifies what type of medical care you want or do not want if you are unable to make that decision at the time. You can also indicate if you’d like to donate all or part of your body upon death, whether through organ or tissue donation or for the sake of scientific study.

Florida legislation (Chapter 765, Florida Statutes) recognizes that competent adults have the right to make advance directives so that their health care decisions will be respected should they become incapacitated. Such advance directives can instruct physicians to provide, withhold or withdraw life-prolonging procedures in the event of a terminal illness, an end-stage condition or a persistent vegetative state.

We get it. Those aren’t exactly pleasant thoughts. But if you don’t address these very personal issues, it will come down to someone else making those decisions for you. And that doesn’t always work out so well, as you may remember from the tragic case of Terri Schiavo.

Learning From Others’ Pain

Schiavo, who lived in St. Petersburg, Florida, was only in her late 20s when she suffered a cardiac arrest on February 25, 1990. Although resuscitated, Schiavo experienced massive brain damage due to lack of oxygen to her brain, leaving her comatose. After no improvement, her diagnosis was changed to persistent vegetative state.

Schiavo’s husband and legal guardian, Michael Schiavo, said she wouldn’t have wanted prolonged artificial nutrition and hydration without prospect of recovery and wanted her feeding tube removed. Her parents, Robert and Mary Schindler, however, fought to continue the support that was keeping their daughter alive.

What followed were fifteen years of highly publicized legal challenges, involving state and federal politicians, all the way up to the level of President George W. Bush. Ultimately, Schiavo’s feeding tube was removed for a final time on March 18, 2005, and she died in a hospice facility on March 31, 2005. All those appeals, petitions and legal suits would never have taken place if Schiavo had signed a living will designating her end-of-life wishes before that fateful day in 1990. Schiavo’s family would still have been heartbroken, but at least there would have been no doubt as to what she wanted under the circumstances. Perhaps the greatest benefit of Schiavo’s sad story is that when her case was in the news, it prompted many Americans to think of their own mortality and to make their final wishes known via living wills.

Thinking Ahead

“People do not like to think about dying so they delay executing estate planning documents. Less than 50 percent of Americans execute a living will and last will and testament,” notes Susan Dean of Dean and Dean Attorneys at Law, which has offices in Ocala, Beverly Hills and The Villages, Florida. “The fact of the matter is that failure to address these issues in an estate plan is a disservice to your family and loved ones.”

Dean emphasizes that every adult should execute a living will if they do not want artificial life-prolonging procedures in the event of a terminal illness or a situation such as Terri Schaivo’s.

“Additionally, people should execute a health care surrogate naming an individual to make health care decisions, carry out their wishes and receive health care information in the event of their incapacity,” adds Dean. The person you choose as a health care surrogate should be someone you know well and completely trust to uphold your requests. This person should be able to stand in as your surrogate if disagreements arise between other family members about your care. Realize that if you do not have a living will and are not able to express your wishes at the time, treatment will be determined by your doctors and family members.

Here’s the best part: You can create a living will and designate a health care surrogate at no cost, so there’s really no excuse to put it off. Free forms are available online and at the information desk of your local hospitals.

A popular website, agingwithdignity.org, offers Five Wishes, a free living will that is written in everyday language. You can order a printed Five Wishes document to be mailed to you or complete it online and print copies.

No Lawyer Needed

Advance directives can be part of comprehensive estate planning, but a lawyer is not necessary to prepare a living will or health care surrogate. Requirements vary from state to state, but in Florida, the forms don’t even have to be notarized to make them legally binding.

“A living will and health care surrogate must be signed by the individual in the presence of two subscribing witnesses, one of whom is neither a spouse nor a blood relative of the individual,” Dean explains. “Also, the person who is designated as a surrogate in the health care surrogate document is not able to act as a witness to execution of the document designating such person as the health care surrogate.”

Once you have completed and signed the forms, you should provide copies to your health care provider(s), attorney (if you have one) and family members/significant people in your life. Obviously, whomever you have chosen as your health care surrogate should have copies, as well.

Keep a copy for yourself wherever you file important papers. It’s also wise to keep a card in your wallet/purse stating that you have a living will and the location of this paperwork.

“When a health care surrogate’s authority has commenced, if the health care surrogate is not the individual’s spouse, the surrogate must notify either the individual’s spouse or adult children of the individual’s designation of the surrogate,” adds Dean.

What if you’re a “snowbird” or live in another state part of the year?

“Snowbirds do not need separate documents for each state, although we recommend they keep their living will and health care surrogate with them when they travel,” says Dean.

If you’ve already completed a living will in another state according to that state’s law, but end up needing medical treatment in Florida, that document can be honored in Florida.

Family Matters

OK, so you’ve taken the steps and executed a living will and health care surrogate. Now, what about your parents? Have they done the same?

Grown children should raise this topic with their parents—ideally before there’s a health crisis, because then it could be too late. Dean highly recommends initiating discussions concerning estate planning when family members are healthy.

One way to introduce the topic is to share with them that you have executed a living will and wondered if they have one, as well. Emphasize your concern that their wishes being upheld are of utmost importance.

Making Plans

What if you’ve executed a living will and health care surrogate and then change your mind about certain details?

Not a problem. All you have to do is destroy the existing directive, write a new one and have it signed by witnesses, as required by Florida law.

If you simply want to make a change or addition to an existing directive, just write in that information, sign and date it. Don’t forget to make new copies of the paperwork and give these updated copies to everyone who received the original forms.

As a competent adult, you have the right to make decisions about your health care. This includes the right to choose—or refuse—medical treatment or intervention. Take action today. Execute a living will and choose a health care surrogate. You’ll be doing your loved ones—and yourself—a favor, saving everyone confusion and uncertainty at one of life’s most difficult moments.

Learn more › 

Hospice of Marion County provides copies of Five Wishes at no charge to members of our community who live in Marion County. To request your free copy, please call (352) 854-5230 or e-mail [email protected]. If you are outside of Marion County and are interested in obtaining the Five Wishes document, please visit agingwithdignity.org, where the copies will run $5 each.

Getting Down To Details

Your living will can address a variety of medical care decisions. Just so you know, it’s not necessary to have an advance directive or living will to have do not resuscitate (DNR) and do not intubate (DNI) orders. Your physician can include this preference on your medical records at your request. When you do create a living will, it should specify if such orders are already on file.

Not sure about the details involved with end-of-life care? Before executing a living will, you can ask your health care provider if you have questions or concerns about if—or for how long—you would want any of the following measures:

Resuscitation: Restarts the heart if it’s stopped beating using cardiopulmonary resuscitation (CPR) or electric shock

Tube feeding: Nutrition and hydration via intravenous or stomach tube

Mechanical ventilator: Breathes for you if you can’t

Dialysis: Provides kidney function if yours aren’t working

Palliative care: Interventions to manage pain and keep you comfortable (may include being allowed to die at home, etc.)

Wills vs. Living Wills: What’s the Difference?

A “living will” (also known as a “health directive”) addresses end-of-life medical care and ends when the person who executed the document dies. A “last will and testament” directs the distribution of the individual’s assets after death and becomes legally binding at the death of the person who made the document.

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