EVERYTHING YOU EVER WANTED TO KNOW ABOUT A LIVING WILL, ADVANCED DIRECTIVES, HEALTH SURROGATE, DNRO, ETC. BUT WERE AFRAID TO ASK.
The
rascal sage Nasrudin stood on the bow of a ferryboat next to a pompous
professor. "Have you ever studied astronomy" asked the professor.
"I can't say that I have," answered the
mystic.
"Then you have wasted much of your life," the scholar declared.
"Knowing the constellations, a skilled captain can navigate a boat around
the entire globe."
A while later the intellectual asked Nasrudin, "Have you studied
meteorology?"
"No," answered Nasrudin.
"Then you have wasted most of your life," chided the academician.
"Methodically capturing the wind can propel a sailing ship at astounding
speeds."
Another while passed, and the professor continued to quiz Nasrudin, "Have
you ever studied oceanography?"
"Not at all."
"My, how you have wasted your time! Awareness of the currents helps sailors
find food and shelter."
A few minutes later Nasrudin approached the professor and nonchalantly asked
him, "Have you ever studied swimming, doctor?"
"Haven't had the time," the professor answered haughtily.
"Then you've wasted all of your life. The boat is sinking."
Once you have a living will, if you want a copy filed at Seraphim Center, which is strongly suggested by the authorities, we will gladly provide that service. If you have some special wishes about arrangements after your passing, funeral and other, we will also be willing to have these on file and do everything we can to make sure they are followed. Read on for a very comprehensive discussion of LIVING WILLS.
Dear
Abby
I saw my handsome, 6 foot, 200 pound father waste away in misery to an 88 pound
skeleton after fighting a two year battle with caner.
The doctors told us it was hopeless, yet they kept that poor dear man
alive month after month, with transfusions, tubes, needles and drugs while he
prayed daily to God to take him. Abby
would you do millions of readers a priceless service by acquainting them with
the living will.
Grateful in
Dear Readers,
By now, the importance of having an advance directive – or living will- should
be apparent to everyone. Contrary to
what many people may believe, this is not just a document for old people.
A living will is simply a document that instructs your physician, lawyer,
pastor, family members – even a few trusted friends – what your wishes are
if there is no hope for your recovery and you are unable to speak for yourself.
I
have a living will and I hope that the people who love me will respect it.
Mine states that if there is not hope for my recovery and all hope for
life is gone, or I lose my sense of reason, I do not wish to be kept alive by
artificial means.
A
Matter of Life and Death,
the Schiavo Case Spurs More Americans to Weigh Living Wills
Bonnie
Simmons doesn't want things to end for her the way they have for Terri Schiavo, the
Simmons,
72, of Celebration,
Simmons
isn't alone. Since the Schiavo case made national headlines end-of-life experts
and attorneys are fielding an unprecedented number of calls.
Paul
Malley, president of Aging with Dignity, a nonprofit group that assists families
with end-of-life issues, says he's seen a tenfold increase in calls in the past
few weeks.
People
are acting to avoid the type of situation that has torn apart the family of
Terri Schiavo, the 39-year-old woman who lived 13 years in what doctors
described as a persistent vegetative state. Most of us know more details about
this case than we really want to know.
About
25-40 percent of American adults have a living will, which specifies the medical
treatment people do or do not want if they become terminally ill or
incapacitated. All states recognize living wills and a second type of advance
directive, the durable medical power of attorney.
A
durable medical power of attorney, also called a health care power of attorney,
is a document in which an individual appoints someone to make decisions about
health care if he or she is unable to do so.
Simmons
is using "Five Wishes," a document developed by Aging with Dignity.
Five Wishes, recognized by
To
ensure that dying wishes are honored, experts urge all adults to complete both a
living will and a health care surrogate or power of attorney.
"A
Living Will should be the summation of the conversation you've had with your
family," says Sally Hurme, an AARP consumer protection attorney. "An
advance directive is not just to terminate care but to express your preference
for the care you wish to receive," she adds.
Meanwhile, Simmons says she will tell her doctors and family "just don't jump the gun" if she becomes incapacitated. While Simmons will make clear that she wants all attempts to recover taken, she does not want any heroic steps to continue her life if doctors decide she has no chance of recovery. “I have lived well and my family loves me and they know I love them, we have had a wonderful life together and to prolong an inevitable death for a few days, at staggering costs, and no quality of life, is just not worth it to me or my family,” says Simmons.
Dying
well, to many, means control over choices to be made as we die.
We fear dying in pain; we fear that too much will be done to keep us
alive, or we fear that not enough will be done. We need to look at the issues
surrounding efforts to control how we die and the implications for families,
institutions, and communities.
Facing
death calls for hard choices, whether you are a patient, a family member, or a
professional caregiver. With modern medicine able to prolong life through a
battery of invasive procedures like breathing, feeding, and hydration tubes,
most people will have to decide when invasive life-support procedures are called
for.
If
started, when should they be discontinued, and who should decide? What role
should palliative care play in end-of-life decisions? How can patients be sure
of getting the pain medication they need to remain comfortable?
Will
the medication relieve their pain at the cost of their awareness?
What
relief can hospice provide and when should it be called in?
Compassionate concern for others’ pain and suffering, they new thinking
says, should begin with a commitment
to keep dying patients as comfortable and alert as possible. In fact, they point
out, when good hospice care is available; most patients have a very gentle and
peaceful death.
Speaking Out,
WHAT YOU SHOULD KNOW ABOUT THE TERRI
SCHIVO CASE by Thomas R. Weller
Terri Schiavo’s case put this country into an emotional melt-down.
What the vast majority of people don’t realizes that it is not an
emotional issue to the courts.
When
a case comes before a trial court, that court must determine the appropriate law
by which to rule on the case, and must deter" mine the facts upon which to
base its decision.
The courts of
The
court gave no greater weight to Michael Schiavo's testimony just because he was
her husband. Imagine that the court heard arguments about the fact that he had
another family, but still decided that it was Terri Schiavo's wishes that food
and water be withdrawn..
The court did not make a decision that her
husband had a right to have her food and
water taken away. It merely made the factual determination that Terri Schiavo
wanted food and water to be
withheld. John Adams described this nation as a government of laws, arid not of
men. By these words, he conveyed the thought of
all the framers of the U.S.
Constitution that the whims or emotions
of one person (King or
his appointees) could not determine the outcome of
an issue needing resolution.
All
who have sat on a jury have heard the judge instruct them that they are to make
their decision upon the testimony they have heard, the evidence presented, and
the law as explained to them. They are not to base their decision upon emotion. or
prejudice.
When
the' Constitution was discussed and drafted, the framers recognized that the
powers of the states were primary, but in order for there to United States,
the states would have to give up some of their powers concerning certain issues
to the new federal government. The framers then divided the federal government
into three distinct branches. Congress passes laws affecting the areas of
concern the states allowed the federal government to address. The president
enacts the laws by signing them. But it is the federal courts that determine if
the laws passed are within the original intent of the
framers of the Constitution, to see if those laws are
"constitutiona1."
It. has long been recognized that the areas of law concerning the
family and the right to privacy are within the purview of the states.
Consequently, laws passed by Congress that infringe upon these areas of the law
are unconstitutiona1.
This will explain why the U.S. Supreme Court did not get involved, why
members of Congress who respected our Constitution did not vote for any
legislation regarding Terri Schiavo and why federal courts found any laws
passed by Congress unconstitutiona1.
This will partially explain why the efforts of the Florida Legislature
were determined to be unconsttutiona1. The other reason why efforts by our
state legislators (who either have little knowledge of the Constitution or
regard for it) were unsuccessful is because neither the state, nor our
federal government can pass a law affecting just one person.
This
is that old "government of laws and not of men" thing again.
Those
who question the justices, who have been involved with the Terri Schiavo case,
do not understand the U.S. Constitution, the separation of powers doctrine,
nor how our courts are not concerned, with emotions.
If' courts concerned
themselves with emotions, there could not be a government of laws and not of
men. (Instead it would be a government of mob rule, where the majority stuffed
their will down the throats of the minority.
In a true democracy the majority rules but the rights of the minority are
always protected.)
(Thomas R. Weller, an attorney who lives in High Springs.) More info at
http://abstractappeal.com/schiavo/infopage.html
LIVING
WILL
Congratulations
on taking the first step in protecting your right to freedom and choice at the end of life.
These documents will help ensure that you continue to make your own health care
decisions. They over not only personal autonomy, they also give you
and your loved ones peace of mind, knowing that your wishes are firm and clear.
1.
Check to be sure that you have the materials for your state.
2. Included are (1) Instructions for preparing your advance directive and (2)
Your state-specific forms
3.
Photocopy these forms before you start so you will have a clean copy if you need
to start over.
4.
Read the instructions in their entirety and fill in each bank carefully as
instructed
5.
Talk with your family, friends, and physicians about your decision to complete
an advance directive.
This packet contains two (2) legal documents that protect your right to refuse
or accept medical treatment in the event you lose the ability to make decisions
yourself:
1. The Florida Designation of Healthcare Surrogate lets you name
someone to make decisions about your medical care—including decisions about
life support—if you can no longer speak for yourself. The Designation of
Healthcare Surrogate is especially useful because it appoints someone to speak
for you any time you are unable to make your own medical decisions, not only at
the end of life.
2.
The Florida Living Will lets you state your wishes about medical care
in the event that you have an end-stage condition, become persistently
vegetative, or develop a terminal condition and can no longer make your own
medical decisions. A second doctor must agree with your attending physician’s
opinion of your medical condition. Last Acts Partnership recommends that you
complete both of these documents to best ensure that you receive the medical
care you want when you can no longer speak for yourself.
Note: These documents will be legally binding only if the person
completing them is a competent adult (at least 18 years old).
COMPLETING
YOUR
Whom should I appoint as my surrogate? A
surrogate is the person you appoint to make decisions about your medical care if
you become unable to make those decisions yourself. Your surrogate can be a
family member or a close friend whom you trust to make serious decisions. The
person you name as your surrogate should clearly understand your wishes and be
willing to accept the responsibility of making medical decisions for you. You
can also appoint a second person as your alternate surrogate and they will step
in if the first as surrogate is unable, unwilling or unavailable to act for you.
How do I make my
Should
I add personal instructions to my
What
if I change my mind? You can always
revoke your Florida Designation of Healthcare Surrogate if you no longer want
them to make decisions on your behalf. State law permits you to revoke your
document in the following ways:
1.
Through a signed and dated
writing showing your intent to revoke;
2. By physically destroying the original, or having someone destroy it
for you in your presence;
3. By orally expressing your intent to revoke; or
4. By executing a new Designation of Healthcare Surrogate that supersedes
the older document.
Pregnancy?
If you desire to add pregnancy to these documents, you must add in the
“Additional instructions.” such as, “My surrogate has the authority to
order the withholding or withdrawal of life-sustaining treatment even if I am
pregnant.”
How do I make my
Can I add personal instructions to my Living Will ? Yes. You can add personal instructions in the part of the document called “Additional instructions.” For example, you may want to refuse Specific treatments by adding a statement such as, “I especially do not want cardiopulmonary resuscitation, a respirator, artificial nutrition and hydration, or antibiotics.” You may also want to emphasize pain control by adding instructions such as, “I want to receive as much pain medication as necessary to ensure my comfort, even if it may hasten my death.” If you have appointed a surrogate and you want to add personal instructions to your Living Will, it is a good idea to write a statement such as, “Any questions about how to interpret or when to apply my Living Will are to be decided by my surrogate.” It is important to learn about the kinds of life-sustaining treatment you might receive. Consult your doctor.
What
if I change my mind? You can
revoke your Florida Living Will any time you feel the document no longer
reflects your wishes. State law permits you to revoke your Living Will in the
following ways:
1 . through a signed and dated writing showing your intent to revoke;
2.
by physically destroying the original, or having someone destroy it for you
in your presence;
3.
by orally expressing your intent to revoke; or
4.
by executing a new Designation of Healthcare Surrogate that supersedes the
older document.
What other facts should I know? You
may appoint a surrogate in your Living Will to make decisions on your behalf.
Unlike a surrogate appointed in your Designation of Healthcare Surrogate, a
surrogate appointed through your Living Will may only act when you are unable to
make treatment decisions and have an end-stage condition, or are in a terminal
condition; or are in a persistent vegetative state. To
avoid confusion, you should appoint the same person to act as your surrogate in
both
1. Your Florida Living Will and Florida Designation of
Healthcare Surrogate are important legal documents. Keep the original signed
documents in a secure but accessible place. Do not put the original forms in a
safe deposit box or any other security box that would keep others from having
access to them.
2.
Give photocopies of the signed originals to your surrogate and alternate
surrogate, to your doctor(s), family, close friends, clergy and anyone else who
might become involved in your healthcare. If you enter a nursing home or
hospital, have photo-copies of your documents placed in your medical records.
3.
Be sure to talk to your surrogate (and alternate), your doctor(s), clergy,
and family and friends about your wishes concerning medical treatment. Discuss
your wishes with them often, particularly if your medical condition changes.
4.
If you want to make changes to your documents after they have been signed
and witnessed, you must complete new documents.
5. Remember, you can always revoke one or both of your
6. Be aware that your documents will not be effective in the event of a
medical emergency. Ambulance personnel are required to provide cardiopulmonary
resuscitation (CPR) unless they are given a separate order that states
otherwise. These orders, commonly called “non-hospital do-not-resuscitate
orders,” are designed for people whose poor health gives them little chance of
benefiting from CPR. These orders must be signed by your physician and instruct
ambulance personnel not to attempt CPR if your heart or breathing should stop.
Currently not all states have laws authorizing non-hospital do-not-resuscitate
orders. Last Acts Partnership does not distribute these forms. We suggest you
speak to your physician if you would like to receive an actual non-hospital DNR
form. (It
is the form on Yellow paper)
Please
Print the Following
Your Name: ____________________________________________________________
(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 healthcare decisions:
Name: ______________________________________________________________
Phone ________________
Address: ______________________________________________________________
_____________________________________ Zip Code: ________________
If my surrogate is unwilling or unable to perform his or her duties, I wish to designate as my alternate surrogate:
Name:
_______________________________________________________________
Phone _______________
Address: _____________________________________________________________
____________________________________________
Zip Code: ________________
I
fully understand that this designation will permit my designee to make
healthcare decisions and to provide, withhold, or withdraw consent on my behalf;
to apply for public benefits to defray the cost of healthcare; and to authorize
my admission to or transfer from a healthcare facility. Additional instructions
(optional):
I
further affirm that this designation is not being made as a condition of
treatment or admission to a healthcare facility.
I will notify and send copies of this document to the following persons other
than my surrogate, so they may know who my surrogate is:
Name : _______________________________
Address: __________________________
Signed:
___________________________________ Date _________________________
Witness 1 Signed: __________________________ Address: _______________________
Witness
2 Signed: __________________________ Address: _______________________
Please Print the following:
Declaration made this ________ day of _______________________ (month) , ________
(year)
______ I have a terminal condition, or
______ I have an end-stage condition, or
______ I am in a persistent vegetative state and if my attending or treating
physician and another consulting physician have determined that there i s no
reasonable medical probability of my recovery from such condition, I direct that
life-prolonging procedures be withheld or withdrawn when the application of such
procedures would serve only to prolong artificially the process of dying, and
that I be permitted to die naturally with only the administration of medication
or the performance of any medical procedure deemed necessary to provide me with
comfort care or to alleviate pain.
It is my intention that this declaration be honored by my family and physician
as the final expression of my legal right to refuse medical or surgical
treatment and to accept the consequences for such refusal. In the event that I
have been determined to be unable to provide express and informed consent
regarding the withholding, withdrawal, or continuation of life-prolonging
procedures, I wish to designate, as my surrogate to carry out the provisions of
this declaration:
Name:
__________________________________________________________________________
Address: _______________________________________________________________________
______________________________________________ Zip Code: ________________
Address
: _________________________________________________
____________________________________________
Zip Code: ________________
Phone : _____________________________________________________________
Additional instructions (optional, below
or attach additional documents):
Witness 2 Signed: _______________________ Address : _________________________
The
Dementia Provision
Most
Advance Directives become operative only when a person is unable to make health
care decisions and is either “permanently unconscious ”or “terminally
ill.” There is usually no provision that applies to the situation in which a
person suffers from severe dementia but is neither unconscious nor dying.
The following language can be added to any Advance Directive or Living Will.
There it will serve to advise physicians and family of the wishes of a patient
with Alzheimer ’s Disease or other forms of dementia. You may simply sign and
date this form and include it with the form My Particular Wishes in your
Advance Directive.
If I am unconscious and it is unlikely that I will ever become conscious
again, I would like my wishes regarding specific life sustaining treatments, as
indicated on the attached document entitled My Particular Wishes to be
followed. If I remain conscious but have a progressive illness that will be
fatal and the illness is in an advanced stage, and I am consistently and
permanently unable to communicate, swallow food and water safely, care for
myself and recognize my family and other people, and it is very unlikely that my
condition will substantially improve, I would like my wishes regarding specific
life-sustaining treatments, as indicated on the attached document entitled My
Particular Wishes to be followed.
If
I am unable to feed myself while in this condition
I do /
do not (circle
one) want to be fed.
I herby incorporate this provision in to my durable power of attorney for health care, living will and any other previously executed advance directive for health care decisions.
Signature
: ______________________________________________
Date : _____________________
Witnessed: ___________________________ address
_______________________
End-of-Life Choices My Particular Wishes For Therapies that Could Sustain Life
In addition to the information on other Advance Directive forms I have completed, I wish to make my instructions known with respect to specific therapies that could save or prolong my life. This form is meant to inform my physician, nurse or other care provider of my consent or refusal of certain specific
therapies. It is also meant to guide my family or any other person I name to make health care decisions for me if I cannot make these decisions myself. I understand it is impossible to know what a person would want in a particular circumstance, unless that person has previously stated his or her wishes. I hope this document helps those who must make dif .cult decisions to proceed with comfort and confidence. By following these instructions they know they are acting in my best interests and are consenting or refusing certain therapies just as I would if I could hear, understand and speak.
Decisions While I am Capable: So long as I am able to understand my condition, the nature of any proposed therapy and the consequences of accepting or refusing the therapy, want to make these decisions myself. will consult my doctor, family and those close to me, spiritual advisors and others as I choose. But the final decision is mine. If I am unable to make decisions only because I am being kept sedated, I would like the sedation lifted so I can rationally consider my situation and decide to accept or refuse a particular therapy.
Comfort Care: I want any and all therapies to maintain my comfort and dignity. If following my instructions in this document causes uncomfortable symptoms such as pain or breathlessness, I want those symptoms relieved. I desire vigorous treatment of my discomfort, even if the treatment unintentionally causes or hastens my death.
Decisions
for Specific Therapies: If my
mental or physical state has deteriorated, the prognosis is grave and there is
little chance that I will ever regain mental or physical function, I would like
the following (circle answer for each of the eight (8) choices either Yes, or
Trial period, or No):
Yes__Trial
period*__No 1. Antibiotics,
if I develop a life-threatening infection of any
kind.
Yes__Trial
period*__No 2. Dialysis,
if my kidneys cease to function, either temporarily
or permanently.
Yes__Trial period*_ No 3. Artificial ventilation, if I stop breathing.
Yes__Trial period*__No 4. Electroshock, if my heart stops beating.
Yes__Trial
period*__No 5.Heart
regulating drugs including electrolyte replacement, if
my heartbeat becomes irregular.
Yes__Trial period*__No 6.Cortisone
or other steroid therapy, if tissue swelling
threatens vital centers in my brain.
Yes__Trial
period*__No 7.Stimulants,
diuretics or any other treatment for heart failure,
if the strength and function of my heart is impaired.
Yes__Trial
period*__No 8.Blood,plasma
or replacement fluids, if I bleed or lose fluid
circulating in my body.
*This
means doctors may see if the therapy quickly reverses my condition. If it does
not, I want it discontinued.
Signature ______________________________________
Date ________________________
Uniform
Donor Form
The
undersigned hereby makes this anatomical gift, if medically acceptable, to take
effect on death. The words
and marks below indicate my desires: I give:
(a)
_____ any needed organs or parts
(b)
_____ only the following organs or parts for the purpose of transplantation,
therapy, medical research, or education:
(c) _____ my body for anatomical study if needed. Limitations or special wishes,
if any:
Signed
by the donor and the following witnesses in the presence of each other:
Donor’s
Signature ___________________________________
Donor’s Date of Birth _____________
Date
Signed
City
Witness
_____________________________ Witness _____________________________
Street
Address ________________________ Street Address ________________________
Other sources for information on Living Wills, Advanced Directives, Do Not Resuscitate Orders and Durable Power of Attorney:
Aging
with Dignity
www.aginingwithdignity.org
Compassion
& Choices
www.compassionandchoice.org
American
Bar Association
321
North Clark Street
(312) 988-5000
Consumer’s Tool Kit for Health Care Advance Planning
http://www.abanet.org/aging/toolkit/home.html
Living
Will Registry
www.uslivingwillregistry.com
Agency for Health Care Administration
(888) 419-3456
http://www.fdhc.state.fl.us
http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/HC_Advance_Directives/adv_dir.pdf
Do
Not Resuscitate, but do treat with care.
A
Do Not Resuscitate Order (DNRO) is a form or patient identification device
developed by the Dept. of Health to identify people who do not wish to be
resuscitated in the event of respiratory or cardiac arrest.
These
orders are usually reserved for someone who is suffering from a terminal
condition, end-stage condition, or is in a persistent vegetative state.
There are several types of advanced directives that will record the
wishes of those not falling into any of the above categories.
If you are not sure if a DNRO is appropriate for you, or would like
additional information on advance directives, it is best to consult your
physician as well as an attorney.
A
living will is a document that instructs, as specifically as possible, what care
and treatment the person wishes under certain circumstances.
Any competent person can fill out a living will at any time.
A DNRO an additional order, it is a physician’s order not to
resuscitate if a person goes into cardiac or pulmonary arrest.
It is part of the prescribed medical treatment plan and must have a
physician’s signature. It is
usually written for patients who are terminally ill, suffering from an end-stage
condition, or are in a persistent vegetative state.
Pursuant
to Florida Law, the DNRO is honored in most health care settings, including
hospices, adult family care homes, assisted living facilities, emergency
departments, nursing homes, home health agencies, and hospitals.
The
properly completed form will be signed by the competent patient or the
patient’s representative and by a
The
DNRO form should be kept in a noticeable place such as the head of the bed or on
the refrigerator. It should be
readily available in the event of an emergency to ensure that the patient’s
last wishes will be honored.
The
form can be revoked at any time either orally or in writing, but a physical
destruction, by failure to present it, or by orally expressing a contrary
intent.
Attached
to the bottom of the Department of Health’s DNRO form 1895 is a patient
identification device, which may be removed from the form and laminated, and can
be worn on a chain around the neck or clipped to a key chain or to clothing/
bed, etc. so it can travel with the patient.
It is equally as valid as the DNRO Form 1896 and can be presented to
emergency medical services personnel when they arrive on the scene.
It is designated to allow the patient to move between settings with one
document.
The Do
Not Resuscitate Form 1896 can be obtained for free by writing the Department of
Health, Bureau of Emergency Medical Services, 4052 Bald Cypress Way, Bin C 18,
Tallahassee, FL 32399-1738, by calling (850) 245-4440 ext. 2731 or
2742, or by contacting your local ambulance service or by going to www.doh.state.fl.us
and scroll down on “view subject choices” to Emergency Medical Sciences.
THIS
FORM HAS TO BE ON CANARY YELLOW TO BE LEGAL
