Why This Conversation Belongs to Everyone Over 18
Most people associate advance directives with end-of-life planning for the elderly. In Florida, that framing is a mistake — and the Terri Schiavo case made it painfully clear. Ms. Schiavo was 26 years old when she collapsed, and the decade of court proceedings that followed happened precisely because she had never put her wishes in writing. Every adult over 18, regardless of health, should have at least a basic set of directives on file.
At Zimmer Medical Group, we help patients complete these documents as part of routine care. You do not need an attorney. You do not need to be sick. You need about 30 minutes, two adult witnesses, and a willingness to think clearly about what matters to you.
The Four Documents You Should Know
Florida recognizes several distinct tools, each with a specific purpose. Confusing them is common, and using the wrong one can leave a gap at the worst possible moment.
1. Living Will (Florida Statute 765). A living will specifies your wishes about life-prolonging treatments — mechanical ventilation, artificial nutrition and hydration, resuscitation — if you are terminally ill, in an end-stage condition, or in a persistent vegetative state and unable to speak for yourself. It speaks for you only when you cannot.
2. Health Care Surrogate Designation (Florida Statute 765.202). This designates a specific person to make health care decisions on your behalf. Florida's surrogate statute allows you to give your surrogate authority either only when you lose capacity or concurrently with your own decision-making — a flexibility unique to our state. Choose someone who knows you well, can handle pressure, and is willing to follow your stated wishes even when other family members disagree.
3. Do Not Resuscitate Order (DNRO). In Florida, a valid pre-hospital DNRO must be on the state-issued yellow form and signed by a physician. A generic statement in a living will is not sufficient for paramedics in the field. If you want emergency responders to honor a DNR, you need the official document, visible and accessible.
4. Durable Power of Attorney for Health Care. This is broader than a surrogate designation and is often combined with financial POA documents when appropriate. For pure medical decision-making, the health care surrogate form is usually sufficient.
The National Institute on Aging's overview of advance care planning provides a clear plain-language explanation of how these documents work together.
What Happens If You Have Nothing on File
Florida law establishes a default proxy hierarchy when a patient cannot speak for themselves and has no designated surrogate: spouse, then adult children by majority, then parent, then adult sibling, then adult relative, then close friend. This sounds reasonable — until your family disagrees, your spouse is estranged, or your adult children are scattered and unreachable. A surrogate designation is not about distrust; it is about clarity under stress.
How to Actually Complete the Forms
Free Florida-specific forms are available through the state. They require:
- Your signature
- Two adult witnesses
- At least one witness who is not your spouse or a blood relative
- The health care surrogate cannot serve as a witness
You do not need a notary for the basic documents, and you do not need an attorney. Florida Health Finder's advance directives portal provides the official forms and step-by-step guidance. For patients who want broader planning resources, the Department of Elder Affairs program listings connect you to local services including SHINE counselors who can answer Medicare-related questions.
Where to Keep the Documents
A directive that no one can find during a crisis is effectively no directive at all. We recommend:
- One signed copy in your primary care chart (bring it to your next visit — see our patient forms page)
- One copy with your designated surrogate
- One copy with your next of kin
- A copy on your refrigerator or in a clearly labeled folder at home — paramedics are trained to look there
- A wallet card noting where your directives are stored
- A digital copy in a shared family folder or on your phone
This is especially important for St. Pete seniors who are focused on fall prevention and for anyone preparing their hurricane medicine cabinet — evacuations are one of the scenarios where directives most often get left behind.
POLST and What Is Coming Next
POLST (Physician Orders for Life-Sustaining Treatment) and MOST forms are emerging in many states as a way to translate a patient's wishes into immediately actionable physician orders. Florida has been slower to adopt a formal POLST program, but the underlying idea — a portable, physician-signed order reflecting the patient's current goals — is increasingly used in serious-illness care.
When to Update
Review your documents every few years and after any major life change: marriage, divorce, the death of a named surrogate, a new diagnosis, or a child becoming an adult. An outdated directive naming an ex-spouse as surrogate is worse than no directive at all.
Situations Where the Paperwork Gets Tested
Memory loss and the question of capacity
The most common way a directive is actually used in our practice is not a sudden accident. It is the slow arrival of dementia. A diagnosis of mild cognitive impairment or early Alzheimer's disease does not mean a person has lost the ability to decide; capacity is decision-specific and is assessed by the treating physician, not assumed from a diagnosis. That is exactly why the documents should be signed early in the course, while the ability to weigh options is not in question, and why we encourage patients to complete them at the same visit the diagnosis is discussed. The National Institute on Aging's checklist is a good companion for families organizing these papers.
Chronic illness and the decisions your surrogate will face
A surrogate for someone with congestive heart failure, advanced COPD, or kidney failure will be asked concrete questions: another hospital admission or care at home, a breathing machine for a flare, dialysis, a feeding tube. Vague instructions like "no heroic measures" do not answer those questions. Talk through the likely scenarios for your particular illness with your surrogate and your doctor. MedlinePlus has a plain-language overview of what each document can and cannot cover.
Snowbirds, two states, and Medicare visits
Many of our patients spend part of the year in another state. Florida generally honors a directive validly executed under another state's law, but the safest course is to complete Florida's forms as well and to carry a copy with you in both directions. If you are on Medicare, advance care planning is a covered part of the Annual Wellness Visit, so the conversation can happen at a visit you are already scheduled for. Our primary care team keeps the signed copy in your chart and can update it whenever your wishes or your surrogate change.
The Conversation Is the Point
The form matters, but the conversation with your surrogate matters more. Tell them, in plain words, what you would want in common scenarios. Ask your primary care doctor the questions you are afraid to ask. Planning ahead is a gift — to your family, and to yourself.
If you would like to complete or update your advance directives, our concierge medicine program includes unhurried time for exactly these conversations. Schedule a visit and we will walk through the documents together.
