End of Life Decisions
THIS IS YOUR LIFE!
End of life
decisions can be yours also with advance directives. Make sure your
documents reflect your values regarding end of life care. You would not
want to leave your quality of care to chance. It is vital to put your wishes
in writing now while you are able to clearly express them. Your Health Care
Surrogate Designation gives instructions about your health care if, in the
future, you cannot speak for yourself. It also enables you to give someone
the power to make health care decisions for you. A Living Will generally
states your wishes about life-sustaining medical treatments if you are
terminally ill, in a persistent vegetative state or an end stage condition
as defined below.
A terminal
condition, defined in Florida Statute 765.101 (17), is “a condition
caused by injury, disease, or illness from which there is no reasonable
medical probability of recovery and which, without treatment, can be
expected to cause death.”
A
persistent vegetative state, defined in Florida Statute 765.101 (12
a, b) is “a permanent and irreversible condition of unconsciousness in which
there is: (a) the absence of voluntary action or cognitive behavior of any
kind, (b) an inability to communicate or interact purposefully with the
environment.”
An end-stage condition, defined in Florida Statute 765.101 (4), is
“an irreversible condition that is caused by injury, disease, or illness
which has resulted in progressively severe and permanent deterioration, and
for which, to a reasonable degree of medical probability, treatment of the
irreversible condition would be ineffective.”
Section 765.104 of the
Florida Statutes now allows amendment of advance directives in
addition to revocation. The amendment or revocation is effective when
communicated to the surrogate, health care provider or health care facility
and can be accomplished in four ways: (1) by means of a signed, dated
writing; (2) by physically destroying the advance directive or directing
another person to destroy the original document; (3) by orally expressing
intent to amend or revoke; or (4) by signing a new advance directive
materially different from the old one. A health care facility cannot make
the patient sign the facility's advance directives form. The advance
directives must travel with the patient's chart. . If you have documents
that reflect your wishes, do not let the nursing home,
hospital, or any other health care provider talk you into signing new
documents.
Advance directives are
more important than ever.
Since 1990, Florida law has provided for a person to act as a "proxy" if
the patient did not have advance directives in place. The proxy is
chosen from a list that starts with legal guardian, then spouse and family
members all the way to close personal friend. There has been a gap in
coverage when there is no one to serve as proxy. New statute section 765.404
is created to deal with the no family, no friends situation for persistent
vegetative state cases only. The patient must have a judicially appointed
guardian with authority to consent to medical treatment. The guardian
and the patient's attending physician, in consultation with the medical
ethics committee for the patient's facility, must conclude that the
condition is permanent with no reasonable hope for recovery and that
withholding or withdrawing life prolonging procedures is in the patient's
best interests. If the facility has no ethics committee, it must make an
arrangement with another facility to use their ethics committee or a
community-based ethics committee approved by the Florida Bio-Ethics Network.
An inherent danger is that analysis may focus on cost versus benefit,
playing into the hands of the entity paying for care, whether that entity is
Medicaid or private insurance.
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