Advance Directives: Right to Decide (DRops of Wisdom)

Today we continue “DRops of Wisdom,” our physician blog, with Dr. Stewart W. Stein, the associate vice president of medical services for Chapters Health System. He describes the importance of advance directives and how everyone has the right to make healthcare decisions.

Advance Directives

The majority of Americans view voting for elected officials on Election Day as their right. They get to decide on the welfare of their communities, states and country. Equally important are healthcare decisions. When it comes to a person’s health and well-being, everyone has the right to decide whether to seek or refuse medical treatment. Many adults all across the United States, however, do not exercise their right to decide.

Often times, healthcare decisions are made for adults who have become incapacitated—a result of suffering a debilitating stroke, or of developing dementia—by loved ones. Family members might assume they know the individual’s wishes and make healthcare decisions that their loved ones might not have chosen were they able to do so.

How does someone make their healthcare wishes known? They can map out their wishes in the form of an advance directive. An advance directive is the overall plan of a person’s healthcare wishes, that is to say, how much or how little should be done when he or she might not be able to make decisions. Components of an advance directive can include a living will, a healthcare surrogate designation and an anatomical donation.

Despite the fact that the Federal government passed the Patient Self-Determination Act in 1990 requiring hospitals, nursing homes, home health agencies and health maintenance organizations (HMOs) to provide patients with information about healthcare decision-making rights, only about one third of Americans have completed an advance directive. According to a University of Pennsylvania study, researchers discovered that a completed living will had been prepared in only 29.3 percent of cases, and only 33.4 percent of patients had identified a healthcare surrogate. A fully executed advance directive was statistically higher in patients with chronic illnesses compared with their healthy counterparts.

The rationale behind an advance directive is to help ensure that treatment preferences are honored if someone becomes incapacitated and can no longer speak for himself or herself. An advance directive can avoid potential conflicts.

Right to Decide

advance directiveIt is best to make sure that healthcare decisions are in the form of a written statement, or an oral statement made when you are healthy. There are three types of advance directives, which can be executed as part of advance care or estate planning.

A living will is a statement of your wishes with regard to medical treatment in circumstances under which you can no longer express consent. It’s called a living will because it takes effect while you are still living.

A healthcare surrogate is a person designated by you to make and authorize healthcare-related decisions on your behalf. You can include specific instructions about any treatment you want or do not want, similar to what you might have expressed in a living will.

With the passing of Florida Statute 765, you can now choose an immediate healthcare surrogate while you maintain mental capacity. Your choice of a healthcare surrogate can be based on culture or life choice. You also have the right to agree to, or to refuse, any decision made by your healthcare surrogate.

An anatomical donation is a document where you indicate your wish to donate at death all or part of your body. This donation can be an organ, tissue or body, to a person in need or for healthcare training.

It is entirely your choice as to what you want to complete for an advance directive. You can complete one or all three of the previously described options.

Because we are committed to honoring our patients’ preferences for end-of-life care, Chapters Health System now offers another type of advance directive to our hospice patients: “Physician Orders for Life Sustaining Treatment” or POLST. To learn more, please click here.

If you want your wishes known, start by taking the time to have conversations with your family and physician. If you need assistance in getting the conversation started, staff at all affiliates of Chapters Health—Good Shepherd Hospice, HPH Hospice and LifePath Hospice—are available to help.

What Would You Like to Read About in Future Posts?

In “DRops of Wisdom,” we want to feature posts with subject matter that interests you. Please leave a comment or email us with your ideas.

At Chapters Health System, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to

About Stewart W. Stein, MD

As associate vice president of medical services for Chapters Health System, Dr. Stewart W. Stein’s extensive background in end-of-life care and a commitment to the delivery of exceptional hospice services are of great benefit to patients and families.

Frequently Asked Advance Directive Questions

Am I required by Florida law to have an advance directive?

According to Florida law, there is no legal requirement to complete an advance directive. If you do not have an advance directive, healthcare decisions can be made for you by a spouse, adult child, parent, sibling, close friend or a court-appointed guardian. The person making these decisions may not be aware of your wishes. When you create and complete an advance directive, it is always best to make sure that you discuss your wishes with the person or people who would be charged in making sure that your decisions are carried out.

Do I need a lawyer to prepare my advance directive?

You do not need a lawyer to complete an advance directive. To print a sample living will document in English, click here. Para imprimir un documento de ejemplo en español, haga clic aqui.  To print a sample healthcare surrogate document in English, click here. Para imprimir un documento de ejemplo en español, haga clic aqui.

Whether a written document or an oral statement, an advance directive needs to be witnessed by two people and at least one witness cannot be a spouse or a blood relative.

What should I do if I change my mind after I complete my advance directive?

If you decide to make any changes to an existing advance directive, make sure they are clearly written, signed and dated. Also, you can change an advance directive with an oral statement, or by drafting a new advance directive. If your driver’s license indicates you are an organ donor, but you have changed your mind, contact the nearest driver’s license office to cancel the donor designation. You can then have a new license issued.

What if I moved from another state, can my advance directive be used?

If you completed an advance directive in another state, it can be honored in Florida.

Once I have a completed advance directive, what do I do next?

If you have an advance directive, make sure significant people in your life know about its existence and where the documents are located. Set up a file where you can keep a copy of your advance directive (and other important paperwork). Many people keep their original documents in a safety deposit box at their bank. Another safeguard to ensure that your wishes are known is to keep a card or note in your wallet or purse, which clearly states that you have an advance directive and where it is located.


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