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...
|
