Healthcare Advance Directives: Free Will & Personal Autonomy
The Enduring Legacy of Free Will & Personal Autonomy
A longstanding aspect of the Western philosophical tradition is Free Will, the belief that individuals are not bound to a predetermined chain of events they have no control over, but rather have the ability to make decisions that affect the future. Another similar concept is Personal Autonomy, the idea that individuals should decide of their own accord how they want to live their lives and the courses of action that they pursue, with some caveats, of course, like you cannot expect to be free to live a life that endangers, harms, or harasses others as a result of your actions.
These two ideas, Free Will and Personal Autonomy, have been integrated into the American culture and its legal system. You don’t have to look far, the famous Gadsden Flag, which features a coiled rattlesnake on the ground on top of the phrase “DONT TREAD ON ME” (I didn’t miss the apostrophe”) on a yellow background, started off as a representation of the American Revolution’s ideals, among them that a free society is built on liberty, equality, and responsible citizenship (which originates from the concept of Free Will) and that there should be no taxation without representation (which originates from a belief in Personal Autonomy). Today, the Gadsden Flag is a symbol of individualism and liberty, showing how influential the concepts of Free Will and Personal Autonomy have been in American thought.
The Healthcare Advance Directive: Making Sure Your Wishes are Honored
Another example of the enduring influence of Free Will and Personal Autonomy can be found in the Healthcare Advanced Directive. This document, the Healthcare Advanced Directive is like a Power of Attorney, which is a legal document used by a person to give another person the power to make binding decisions on their behalf. But while a Power of Attorney deals primarily with financial, legal, and personal decisions, an Advance Healthcare Directive deals specifically with healthcare decisions.
In Florida, an Advance Healthcare Directive has two core documents: a Living Will and a Designation of Healthcare Surrogate.
Living Wills in Florida
Through a Living Will you can decide if, how, and when to stop receiving life-sustaining care in the event you become incapacitated AND it’s been determined by a physician that you’re in a persistent vegetative state, have a terminal condition, or an end-stage condition.
Per Chapter 765 of the Florida Statutes:
A persistent vegetative state is a permanent and irreversible condition of unconsciousness in where there is the absence of voluntary action or cognitive behavior of any kind and an inability to communicate or interact purposefully with the environment. (e.g. a coma)
A terminal condition 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. (e.g. an untreatable cancer diagnosis where you’re given six months to live.)
An end-stage condition is an irreversible condition that is caused by injury, disease, or illness which has resulted in progressively severe and permanent deterioration, and which, to a reasonable degree of medical probability, treatment of the condition would be ineffective. (e.g. the last month of the same untreatable six-month cancer diagnosis from the previous example.)
Terri Schiavo: How a Living Will Would've Helped
If you recall or have heard about the Terri Schiavo case, where a woman was in a persistent vegetative state for fifteen years because her husband and parents entered into a highly publicized legal battle over the removal her feeding tube, the entire reason the debacle was able to unfold was that Terri did not have a Living Will.
Without one, her husband and parents had to go to court and argue over what they believed Terri would have wanted to be done if she was in the persistent vegetative state. An that spiraled into a media circus that involved the Florida Legislature, the Governor of Florida, the U.S. Congress, and George W. Bush, who was president at the time. Regardless of whose side you were on, you can agree that this family was hurting and did not benefit from having such a personal matter handled in the public eye. A Living Will would have afforded them that.
Designations of Healthcare Surrogate: The Medical Power of Attorney in Florida
Taking a few steps back, if a Living Will allows you to decide who, when, and how “the plug is pulled,” a Designation of Healthcare Surrogate allows you to decide who gets to make decisions regarding the healthcare you receive and who can receive your health information.
Like a Power of Attorney, the person giving authority is called the Principal, but under a Designation of Healthcare Surrogate, the person receiving authority is called a Surrogate instead of an Agent.
The big decision this document allows you to make is twofold. You can decide:
Who makes healthcare decisions for you if you are incapacitated, and
Who receives your health information, both physical and mental.
When is a Designation of Healthcare Surrogate Effective?
However, your named Surrogates don’t just get this authority immediately. Unless you want them to, that is. This is another difference from a Power of Attorney, which under Florida law must take effect immediately.
With a Designation of Healthcare Surrogate, you get to choose when your Surrogate’s decision-making and information-receiving authority go into effect, either immediately or upon your incapacity.
What Happens if My Healthcare Surrogate and I Disagree?
What happens if you and your Surrogate don’t agree on a medical decision? In the event you want your Surrogate’s decision-making authority to take effect immediately, your wishes override the Surrogate’s authority. Similarly, if you’ve specified treatments and decisions you do not want on your Designation of Healthcare Surrogate, the Surrogate will not receive the authority to override your wishes and approve those treatments and decisions.
Similarly, you can decide what healthcare information your surrogate receives and when they receive it. If you want to keep some information private, you must list it on the form. If you’d like this authority to take effect immediately, you must check the box stating so. If not, they won’t be able to receive your health information until you’re incapacitated.
Is There a Statutory Form in Florida?
Speaking of forms, unlike a Power of Attorney, which does not have a statutory form (i.e. a Legislature-approved template) in Florida, the Designation of Healthcare Surrogate and Living Will have suggested forms in Parts II and III of Chapter 765 in Title XLIV of the Florida Statutes respectively.
A Healthcare Advanced Directive Protects Your Free Will & Personal Autonomy
The Living Will and the Designation of Healthcare Surrogate embody the ideals of Free Will and Personal Autonomy found throughout Western philosophy. These documents allow individuals to decide what should be done and who should be allowed to carry out those instructions. But even if incapacity strikes, the wishes of the individual must be followed. These documents allow people to plan for the future and decide what will happen to them, showing the influence of Free Will, and require that their choices be honored, showing the influence of Personal Autonomy.
Tackle the Task with TealAcre
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