About Advance Directives
Choice in Dying
http://www.choices.org
New York, NY

"Advance directive" is a general term that refers to your oral and written instructions about your future medical care, in the event that you become unable to speak for yourself. Each state regulates the use of advance directives differently. There are two types of advance directives: a living will and a medical power of attorney.

What is a living will?
A living will is a type of advance directive in which you put in writing your wishes about medical treatment should you be unable to communicate at the end of life. Your state law may define when the living will goes into effect, and may limit the treatments to which the living will applies. Your right to accept or refuse treatment is protected by constitutional and common law.

What is a medical power of attorney?
A medical power of attorney is a document that enables you to appoint someone you trust to make decisions about your medical care if you cannot make those decisions yourself. This type of advance directive may also be called a "health care proxy" or "appointment of a health care agent." The person you appoint may be called your health care agent, surrogate, attorney-in-fact, or proxy. In many states, the person you appoint through a medical power of attorney is authorized to speak for you any time you are unable to make your own medical decisions, not only at the end of life.

Important Notice: National Public Radio is providing sample documents from the State of Florida so that you can familiarize yourself with the types of provisions and decision making an individual faces when executing a legal document of this sort. Requirements for these directives, indeed the laws governing the interpretation of these sorts of documents, vary from State to State. You should obtain advance directives specifically designed for use in your State.

FLORIDA DESIGNATION OF HEALTH CARE SURROGATE

Name: ___________S A M P L E_______________
                     (Last)          (First)            (Middle Initial)

In the event that I have been determined to be incapacitated to provide informed consent for medical treatment and surgical and diagnostic procedures, I wish to designate as my surrogate for health care decisions:

Name: __________________________________________________

Address: ________________________________________________

_______________________________ Zip Code: ___________

Phone: _________________________________________________

If my surrogate is unwilling or unable to perform his duties, I wish to designate as my alternate surrogate:

Name: __________________________________________________

Address: ________________________________________________

_______________________________ Zip Code: ___________

Phone: _________________________________________________

I fully understand that this designation will permit my designee to make health care decisions and to provide, withhold, or withdraw consent on my behalf; to apply for public benefits to defray the cost of health care; and to authorize my admission to or transfer from a health care facility.

Additional instructions (optional):

I further affirm that this designation is not being made as a condition of treatment or admission to a health care facility. I will notify and send a copy of this document to the following persons other than my surrogate, so they may know who my surrogate is:

Name: __________________________________________________

Address: ________________________________________________

Name: __________________________________________________

Address: ________________________________________________

Signed: _________________________________________________

Date: ___________________________________________________

Witness 1:

Signed: ________________________________________________

Address: _______________________________________________

Witness 2:

Signed: ________________________________________________

Address: _______________________________________________



MORE...



© Copyright Choice In Dying, Inc., 1997. All Rights Reserved. No portion of this work may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system now or hereafter invented, without permission in writing from the Publisher.