When should I prepare my AD?

The best time to prepare your AD is when you are healthy and not anticipating a health crisis. This allows you the time to make preparing the AD a thoughtful process.

When you read further you will be aware of what is involved in preparing and making your AD effective.

Do I need help preparing my AD?

Florida law does not require you to have the assistance of anyone in preparing your AD. However, as you read through this information, you will see that it is advisable to speak with several different persons as you prepare, particularly your immediate family members.

Some persons may want to consult with their attorney, but it is not required by law.

Should I use an existing form or write my own AD?

You may choose either of these alternatives. Regardless, you will have to go through a thoughtful process in order to know what your preferences are and be able to communicate them to your family. There is no one form or type of AD that is universally accepted as the correct one.

If you are preparing your AD at a time when you are healthy, we encourage you to consider using a “Health Care Surrogate” type of AD, whether you are writing your own or using an existing form. It has the advantage of allowing you to name a specific person who will be your decision maker. And, it pertains to any illness when you are incapacitated and health care decisions must be made for you, not just end-of-life issues. If this type of AD is your choice, then our section on information about AD will be particularly helpful to you.

Our section on examples of AD used by Shands Healthcare provides copies of the two types of ADs that Shands HealthCare makes available to patients/families. You may find them useful if you do not want to write your AD completely. In Section O several examples of forms are available on-line. It might be helpful to review each.

What information should I put into my AD?

ADs are made up of two basic parts. One part provides instructions to your physician and to your family. The other component identifies someone to make medical treatment decisions for you in the event that you cannot speak for yourself. We recommend that your AD include both of these parts. Examples are presented below.

Examples of “instructions” that may be included in your AD:

• End-of Life-Information: Think about what quality of life would be acceptable to you when you are approaching death. If you could still speak with and be aware of your loved ones, would you want medical assistance to continue? What if you could no longer be aware that your loved ones were present, would you want to continue life under those circumstances? Other specific information you might include would be whether you want food and water provided through a tube and, if so, under what conditions. Do you want to be pain free with the provision of comfort care, even if pain medication were to reduce your alertness or awareness?
• Do Not Resuscitate and/or Do Not Intubate information: These treatments also pertain to end-of-life, but need to be addressed independently from the previous decisions. If you are dying, and either your heart stops beating or you stop breathing, your physician is obligated to resuscitate you unless you have indicated you don’t want either chest compressions and/or a tube placed down your throat. Requesting DNR and/or DNI in your AD informs your physician that you do not wish to be given CPR or other emergency treatments if your heart stops beating or you stop breathing.
• If you have a long term or progressive illness, you should consult your healthcare provider for information concerning the likely success of resuscitation efforts.
• Organ/Tissue Donation information: After you die, if you wish to donate any organs, tissues, skin, bone, etc., that may be useful in the treatment of other persons, then you would include these instructions in your AD.

Examples of “identifying” who will be your decision maker if you are incapacitated:

• A “proxy” decision maker – If you do not have a specific person you wish to be your decision maker, then you need only provide instructional information in your AD. When you are not able to communicate and have not named a specific person, your physician will use a list provided by the State of Florida (765.401) to determine who will make decisions for you.

  In order of priority, the list is:

  1. The judicially appointed guardian or guardian advocate of the patient

  2. The patient’s spouse

  3. The adult child or adult children who are reasonably available

  4. A parent of the patient

  5. The adult sibling or adult siblings of the patient who are reasonably available

  6. An adult relative of the patient who cares and has regular contact

  7. A close friend of the patient

  8. A clinical social worker approved for the decision maker role

  The disadvantage of this approach is that the first person on the proxy list may not know what your preferences are or may not agree with them. Or, they may not feel comfortable serving as your decision maker.

• A “Surrogate” decision maker – You may name a specific person to be your decision maker – the person who will express your wishes. This person is called a surrogate. The advantage of this approach is that you can name someone you are confident understands and will represent your preferences for treatment when you cannot speak for yourself.

  In Florida law, a surrogate is presumed to know the patient’s wishes, more so even than the proxy. So, if you are married and you are comfortable with your spouse being your proxy, it would be wise to formally appoint him/her as your surrogate.