Advance Care Planning FAQs
Q: Why should I have an advance care plan (ACP)?
A: If you are unable to speak for yourself, having an ACP helps ensure your wishes are honored. It also reduces the stress of the medical decision process on your loved ones and enhances guidance for your health care surrogate.
Q: When should I prepare an ACP?
A: The sooner, the better for all persons over the age of 18 years. You cannot predict when an accident or illness may leave you unable to communicate your choices.
Q: What is an advance directive?
A: A witnessed written document or oral statement that tells your family and physician(s) what kind of medical treatment you want if you are unable to tell them yourself. It includes, but is not limited to, the naming of a health care surrogate and the creation of a living will.
Q: Who is a health care surrogate?
A: The person you appoint to make health care decisions for you when you are no longer able to speak for yourself. Your health care surrogate can:
- Accept, refuse or withdraw medical treatments
- Authorize admission to/transfer from a health care facility
- Speak with your health care team regarding your condition and treatment options
- Review your medical record and authorize its release, if needed
Q: How should I choose my health care surrogate?
A: You want to be sure your health care surrogate is easily accessible and willing to speak on your behalf when needed. He or she should be someone you can count on to honor and communicate your personal wishes even if they do not agree with them. Most people choose a close relative or friend who knows them best.
Q: What is a living will?
A: A witnessed written document or oral statement in which you state whether a life prolonging procedure should be provided, withheld or withdrawn, if you are suffering from a terminal condition, end-stage condition or in a persistent vegetative state.
Q: Who is a health care proxy?
A: A person appointed to make health care decisions for you when you are:
- unable to make decisions
- have not chosen a health care surrogate
According to Florida Statute 765.401, a health care proxy is appointed based on the following "order of priority" to a patient:
- Judicially appointed patient guardian
- Patient's spouse
- Majority of patient's adult children
- Patient's parent
- Adult sibling or majority of adult siblings who are reasonably available for consultation
- Patient's adult relative who has exhibited special care and concern and has regular contact
- Patient's close friend
- Licensed Clinical Social Worker
Q. What is the difference between a health care surrogate and a health care proxy?
A: A health care surrogate is chosen by you prior to becoming unable to make decisions. A health care proxy is selected by your physician and health care facility when you have not chosen a health care surrogate and have become unable to make decisions.
Q: Does an ACP encourage my death?
A: NO. You are not signing an agreement that says that you wish to die. You are making choices for future medical treatment that you do and do not want.
Q: When does my ACP take affect?
A: Your ACP only applies when you lose capacity to make health care decisions.
Q: When does my living will take effect?
A: Your living will only goes into effect when there is little to no chance of recovery. In the state of Florida, two physicians must determine your condition cannot be made any better before life-prolonging procedures may be withheld or withdrawn.
Q: What if I want to die a “natural” death?
A: For a dying individual, cardiac or respirator arrest with no attempt at resuscitation is usually the most merciful method of dying. Some terminally ill patients, or individuals who are healthy but who have reached an advanced age, do not want to be prevented from dying a natural, peaceful death.
If you do not wish to receive cardiopulmonary resuscitation (CPR) when death is near, be sure to discuss this with your physician. Different forms are required depending on whether you are in a community setting or have been admitted to a hospital.
Q. How do I prevent CPR from being performed in non-hospital settings?
A: Your physician should be able to provide you with an out-of-hospital “Do Not Resuscitate Order” (DNRO). You may also call the Florida Department of Health to request a form at (850) 245-4440.
Currently, in the State of Florida, a DNRO (DH Form 1896) must be signed by you (or your health care surrogate, if you are unable to sign) and by your physician. This form is often referred to as the “yellow form” because the form is printed on bright yellow paper. Here are some important tips regarding your DNRO:
- Your DNRO (or a copy on yellow paper similar to the original color) should be prominently displayed in your home.
- You should also consider keeping a copy of the form with you at all times.
- Without the DNRO in hand, emergency medical personnel will ALWAYS attempt resuscitation.
- Your DNRO will be honored in emergency rooms, provided the yellow form is brought to the hospital with you.
- Upon admission to a hospital facility, your attending physician must write a separate “Do Not Resuscitate” (DNR) order for your hospitalization.
- A yellow DNRO is NOT valid once you are admitted to the hospital.
Q: What if I’m admitted to the hospital but don’t want to receive CPR?
A: Your attending physician must write an in-hospital “Do Not Resuscitate” (DNR) order in conjunction with informed consent from you or your health care surrogate. Please note that a DNR is NOT a “do not treat” order. A DNR only affects resuscitation in the event that your heart or breathing stops. Other treatment may or may not be continued depending on your condition, wishes and discussion with your health care team.
Q: What if I change my mind about my ACP?
A: ACPs are never final until capacity to make decisions is lost. You have the right to change your document at any time. Simply complete a new document and destroy the old. Make sure your loved ones, health care surrogate and physician(s) have a copy of the new version.
Q: How often should I revise my ACP?
A: Advances in medical science happen all the time, and the laws about advance care plans can change within the state and across the nation. It is wise to discuss your plan with your primary doctor every few years, after major life events (marriage/divorce, birth/death, retirement or major illness) or whenever you have questions.
Q: Do I need to have my ACP notarized or witnessed by a lawyer?
A: If you are a Florida resident, it is not necessary to notarize your ACP or have a lawyer involved to complete the document. It is required that the document signatures be witnessed by two competent adults other than your designated surrogate, and one witness should not be your spouse or a blood relative. It is best to have someone witness the document signatures who is neither your heir, your family member nor your health care provider(s).
Q: Will my ACP be honored if I become ill in another state?
A: Most states will honor another state's advance directive. Every state has its own laws governing living wills, health care surrogates and DNROs. To help ensure your wishes are honored, it is important you check the laws of states where you spend time.
Q: What do I do with my ACP after I complete the form?
A: After your ACP is completed, make certain you have signed and dated the form. Always keep your original document along with your other important legal papers. Provide your hospital with a copy of your ACP each and every time you are admitted to the hospital. In addition, provide a copy to any doctor who participates in your care. You should discuss your choices and goals for care in detail with your designated health care surrogate and those who care for you.
Q: How can I make sure that my wishes are followed?
A: Your ACP should be part of your medical record. It should be readily available to doctors and other health care providers. It is important to include your health care surrogate and your family in your planning, keeping them informed of your wishes, and providing them with copies of your ACP.
These FAQs have been prepared as general information for the residents of the State of Florida. While prepared in conjunction with health care professionals and attorneys, it is general information and does not encompass specific advice. Because laws and regulations are subject to change and vary from state to state, this information should not take the place of legal counsel. If you have specific questions regarding your situation, we urge you to obtain competent medical or legal advice.