If you’ve been admitted to a hospital for surgery or for an emergency illness or accident, you’ve been asked to provide copies of or to fill out “advance directives” to put into your medical record. Primary care physicians and advanced practice providers, such as nurse practitioners and physician assistants, may also ask about your advance directives during office visits or annual physicals.

While most people recognize the terminology and tie it to their healthcare, many may not understand how having advance directives helps their loved ones and their healthcare providers make important decisions regarding their care.

Thomas Swope, executive director of Independent Living Hospice and Palliative Care in Miami, sees firsthand how advance directives ease the guesswork of facilitating desired and compassionate care.

“When we ask about ‘advance directives,’ we’re generally referring to two separate documents—the Living Will and the Designation of Healthcare Surrogate,” Swope explains. “They both direct loved ones and healthcare providers how to care for patients in the event that those patients face a terminal illness or become unable to make healthcare decisions for themselves.”

Swope says the Living Will component of the advance directives captures a patient’s wishes for care when a terminal illness has been diagnosed and as it progresses. The Designation of Healthcare Surrogate names the individual whom the patient wants to speak and act on his or her behalf if he or she becomes unable to make healthcare decisions. Notably, this designation does not give the specified person any power over the patient’s financial assets. A third component in the state of Florida—the Five Wishes—allows patients to further elaborate on different aspects of their care to ensure their wishes are carried out. 

Designating a Healthcare Surrogate

“Because the Living Will is tied to care when a patient is diagnosed with a terminal illness or faces end-of-life care, I often recommend that people focus first on establishing their healthcare surrogate,” Swope suggests. “This part of the advance directives isn’t necessarily tied to a person’s death and covers people in the event of abrupt, unplanned medical events, such as a car accident or sudden illness.”

The healthcare surrogate allows decisions to be made on the patient’s behalf, so care is not delayed. The Designation of Healthcare Surrogate should be reviewed regularly, Swope recommends, in case health circumstances change or the healthcare surrogate is no longer the best person to make those decisions. The most recently dated document determines who may act and speak on a patient’s behalf. The healthcare surrogate doesn’t have to be a family member.

Swope also suggests giving a copy of your most recent Designation of Healthcare Surrogate to your primary doctor for your medical record. Keep the original in a safe, yet accessible, location for the designated healthcare surrogate.

Establishing a Living Will

A living will captures the patient’s wishes for end-of-life care. This component of the advance directives instructs healthcare providers when to provide lifesaving care, when to initiate hospice care or palliative care, and when to withdraw care altogether. It can cover decisions regarding the use of a feeding tube, ventilator usage and resuscitation, among other wishes.

“Within hospice or palliative care, living wills empower patients to specify how they want to be cared for,” Swope says. “They eliminate the guesswork and prevent family members from facing the additional burden of making decisions they are unsure about. These advance directives allow the patient’s wishes to be honored by loved ones and by the healthcare team.”

Executing Advance Directives

While advance directives are legally binding, they can be simply executed, Swope explains. At Independent Living Hospice and Palliative Care, nurses and social workers help patients and their families obtain the proper forms, downloadable for free from the Florida State Hospice and Palliative Care Association. Notarizing the documents is preferred but not required, as long as the patient’s signature is witnessed by two non-blood relatives. Originals should be kept with other important documents such as birth certificates, marriage licenses and passports, and copies should be shared with healthcare providers for the medical record. 

Swope emphasizes that while having advance directives helps keep your healthcare desires in your own hands, he also stresses the importance of having these discussions with your loved ones prior to an illness diagnosis or emergency situation. “It helps everyone if these discussions are had ahead of a health crisis,” he says. “Knowing your loved one’s wishes and having the documentation to confirm those wishes avoids guessing and helps honor your loved ones’ health decisions.”