End of Life Planning: Make Sure Your Wishes Are Understood

Most of us know how we would like to be treated if we become seriously ill or incapacitated, and the arrangements we want to make for the end of our lives, but we do not like to talk about it.  

Anyone getting care in a medical facility must be given information about creating an advance directive. An advance directive is a legal document that allows you to decide ahead of time what types of medical care you want to receive if you become incapacitated. You can state whether you want to want to receive aggressive medical treatment to sustain life, or just want to be made comfortable at the end; who you want to make medical decisions for you; and whether you want to be an organ donor.  In 1990, Congress passed the Patient Self-Determination Act (PSDA) requiring all health care agencies to recognize advance directives.

Do not wait until you are in the hospital to fill out an advance directive form. During a crisis, family members sometimes disagree about medical treatment for emotional or religious reasons. By making arrangements and discussing them with loved ones before the situation arises, you can spare them anguish and uncertainty at a very distressing time.

State laws about advance directives vary, so it is important to locate the documents for the state where you live. The state of Florida recognizes the following:

• Living will: A document stating  whether you want  life-prolonging medical care provided, withheld, or withdrawn.
• Health care surrogate: A legal document designating another person to make decisions about your medical care if you become unable to do so.
• Do Not Resuscitate Order (DNRO): An official form from the Florida Department of Health stating that you do not wish to be revived if you are not breathing or if your heart stops.
• Durable Power of Attorney (DPOA): A document naming another person to act on your behalf in financial and legal matters as well as medical treatment.

A written advance directive becomes legal as soon as it is signed by the person making the directive and two witnesses. You do not need a lawyer.

• You can change or cancel these documents at any time. A new, signed document immediately replaces the old one.
• An advance directive never expires. Review it periodically to make sure it still reflects your wishes.
• The advance directive does not go into effect until two physicians declare that you are unable to make decisions for yourself and you are in the medical condition described by your state's living will law.

Advance directives are not only for the elderly. Anyone can become incapacitated by a sudden illness or an accident. It takes only a few minutes to fill out a form. Five Wishes, available online at www.agingwithdignity.org, is a popular living will written in everyday language. It is recognized as a legal document in 42 states, including Florida. You can also purchase a software package online or at a bookstore, or get forms from a local nursing home or health care provider.

Hospice care offers comfort and support for people with terminal illnesses and counseling for family members. Most hospice services are paid for by Medicare, and are an alternative to remaining in the hospital.  

Make sure your wishes will be carried out by telling your loved ones about your end-of-life choices and your advance directive. Tell them where it is located, and give a copy to your health care provider and to the person who will be your health care surrogate or DPOA.

For more information:

• The state of Florida End of Life Issues: A Practical Planning Guide
• Making Choices: A Guide to End-of-Life Planning. Florida Department of Elders. 2005
• To locate state-specific advance directives, see Caring Connections.
• American Association of Retired Persons (AARP) (Type “advance directives” in the website’s search engine)