What Are They?
When most people think of Advance Health Care Directives, they are usually thinking of two separate legal concepts: the Health Care Surrogate and the Living Will. Sometimes these concepts are combined into one document. But at Oakstone Law, we believe they are easier to understand – and easier to get to the right people – if they are two separate documents.
These two documents allow you to plan ahead and make your medical and end of life wishes known before the anxiety and stress that comes with a serious illness or injury. They provide security for you, in knowing that your wishes are laid out. And they provide relief for your loved ones from making tough decisions without your guidance.
Health Care Surrogate Designation:
The Health Care Surrogate Designation is a legal document appointing someone to make health care decisions for you. Historically, this document has been designed to become effective only in the event you become incapacitated, which is not always easy to determine or prove. However, recent changes in Florida law now permit you to decide exactly when your Health Care Surrogate is able to act.
The Health Care Surrogate will advocate for you, in accordance with your wishes as expressed in the document and also in the Living Will (see below), on a wide range of medical treatments. You can think of your Health Care Surrogate as having your “medical power of attorney.”
The Living Will is a legal document that states your wishes for medical treatments and interventions should you be unable to express those wishes yourself. It is not really a Will at all, because it has nothing to do with what happens to your assets. But it is called a Living Will because it takes effect while you are still alive.
If you have dementia, a terminal condition, end-stage condition, or are in a persistent vegetative state, your Living Will can provide direction to your health care providers and loved ones.
You can think of your Living Will as a form of letter from you to your family to tell them: “This is what I would do about me if I could.” This document can help relieve pressure for your loved ones, because they are following your instructions, not making their own decision.
Many medical care decisions can be covered in your Living Will, such as:
- Artificial Nutrition and Hydration- whether to permit feeding and hydration tubes, which are considered life-prolonging treatments.
- Resuscitation- restarting the heart after it has stopped beating.
- Dialysis- removal of waste from your blood if your kidneys are no longer functioning.
- Antibiotic or antiviral medications- medications used to treat infections.
- Mechanical ventilation & breathing devices.
- Comfort Care- interventions to keep you comfortable and manage your pain. This can include home health care options or pain medications.
- Organ and Tissue donations- life-sustaining treatments may continue until organs you’ve chosen to donate can be safely removed.
- Donation of your Body for scientific Research- if this is desired, you will want to contact medical schools and donation programs well in advance.
- Hospice- end of life care, usually up to 6 months. This is not treatment but rather managing your final days with dignity and as pain-free and comfortable as possible. Services can be offered in home or in a facility and include medical, psychological, and spiritual support.
Who Should You Choose?
Choosing a Healthcare Surrogate is a very personal decision. It may not always be the most compassionate daughter or the favorite nephew. You need someone that despite their own feelings and ethics will follow your wishes and will have the strength to make the tough decisions.
It is best to choose a single Surrogate to serve at any one time and have successor Surrogates listed should they be unable to serve. Different family members or friends can have varying interpretations and values. Add in the stress of a sick loved one, and the situation can become combative and conflict fueled. To avoid delay in decision making, one agent is recommended.
Talk frequently with your Surrogate and loved ones about what your medical goals are and what quality of life means to you. Remember, it takes more than love to follow someone’s wishes in a crisis, it takes mental strength and conviction.
What About The DNR or DNI?
Do Not Resuscitate (DNR) and Do Not Intubate (DNI) are not considered advance directives, rather they are medical orders. These are filled out at your care providers’ office or at the hospital. They should be made known to your medical doctors and kept in your medical record.
Where Do You Keep Them?
Copies of these documents should be kept:
- At home;
- In the medical records of your health care providers;
- With your Health Care Surrogate;
- With your attorney; and
- With an always-available online document service such as Docubank (at Oakstone we provide this service for our clients for whom we’ve prepared these documents – contact us for more info).
Recently the Collier County Sheriff’s Department has begun a program called SMART 911. By filling out a profile on the Sheriff’s website, Emergency Medical Services (EMS) can have access to information like:
- Who lives in your home, floor plans of your home and access information;
- What pets you have;
- Medical conditions, allergies, disabilities and medications; and
- Emergency contacts, important addresses and vehicle information.
Remember To Update:
Just like all of your Estate Planning Documents, it is important to keep your Living Wills and Health Care Surrogate Designations updated regularly. How you feel as a healthy 65 year old may be different from how you feel at age 85 with a chronic medical condition. For example, the aging process affects how you recover from something like CPR.
It is also important to update as situations change such as divorce or death in the family. Keeping your Living Wills and Health Care Surrogate Designations current prevents complications and delay when you need it.
Please get in touch with us if you’d like to discuss any of these thoughts, and if you’d like to update your Living Wills and Health Care Surrogate Designations.