The Georgia Advance Directive for Health Care form is an invaluable legal tool that enables you to assert your preferences for medical treatment and designate an individual to make health care decisions on your behalf should you become unable to do so.
This comprehensive document serves as your voice when illness or incapacitation may render you unable to express your wishes.
Remembering that this document isn’t just about you as an individual is vital.
It also serves a critical role in protecting the rights and responsibilities of your designated healthcare agents, family, healthcare providers, and anyone else involved in your care.
The form legally communicates your healthcare wishes, offering guidance to your loved ones during challenging times and providing legal protection for those making decisions on your behalf.
This refers to your name. This is important to identify who the directive is for, as there could be others with similar names. This ensures decisions are tied directly to you and not mistaken for someone else.
If your name is “Jane Smith,” it ensures that this is for Jane Smith, born in 1985, not Jane Smith, born in 1973.
Example: You would fill it out as “By: Jane Smith”
Your date of birth is another key identifying piece of information. This adds another layer of unique identification, as there might be more than one person with your name in your city or even your hospital.
Example: If you were born on April 30, 1985, you would fill the space with “04/30/1985”.
This section is for the name of the person you assign to make health care decisions on your behalf when you can’t.
This is the name of the person you’ve chosen to make health care decisions. This person should be someone you trust deeply, as they will be making decisions about your health care when you cannot do so.
Example: “John Doe”
This is the current address of your chosen healthcare agent. It’s essential because it provides a physical location for contacting your agent.
Example: “123 Cherry Lane, Atlanta, Georgia, 30305”
Here you need to provide your agent’s home, work, and mobile/cell phone numbers here. Multiple numbers ensure several ways to reach your agent in a potentially time-sensitive situation.
Example: Home: (404) 123-4567; Work: (404) 987-6543; Mobile/Cell: (404) 789-0123
The email address of your agent is also needed. This offers another avenue for contact, especially when they can’t be reached by phone.
Example: “[email protected]“
This is the person you select to step in if your first choice for a healthcare agent is unavailable or unable to act on your behalf.
These fields should be filled with the same information as the primary agent but for your first backup agent.
If your primary agent can’t act on your behalf, this person steps in.
Example: Name: “Sarah Doe”; Address: “456 Peach Street, Atlanta, Georgia, 30306” ;Telephone Numbers: Home: (770) 123-4567; Work: (770) 987-6543; Mobile/Cell: (770) 789-0123; Email Address: “[email protected]”
As with the first backup agent, these fields should be filled with the same information for your second backup agent.
This person will intervene if your primary and first backup agents can’t act on your behalf.
Example: Name: “James Doe”; Address: “789 Apple Avenue, Atlanta, Georgia, 30307”; Telephone Numbers: Home: (678) 123-4567; Work: (678) 987-6543; Mobile/Cell: (678) 789-0123; Email Address: “[email protected]“
This section pertains to the authority given to your healthcare agent in situations about your body after death.
This includes decisions about the autopsy, organ donation, and the final disposition of your body.
Here you decide whether or not your healthcare agent has the power to authorize an autopsy of your body.
An autopsy is a medical examination of a body after death. It may be necessary for determining the cause of death or for further medical research.
If you want to restrict this power, you will initial the line indicating that your healthcare agent does not have the power to authorize an autopsy.
Example: If you do not want your health care agent to have the power to authorize an autopsy, you will initial the line. It would look something like this: “JS (Initials) My health care agent will not have the power to authorize an autopsy of my body (unless an autopsy is required by law).”
Here you decide if your healthcare agent has the power to dispose of any part or all of your body for medical purposes, including organ donation or donation to a medical study program.
You can restrict this power by initialing the respective lines.
Example: If you do not want your health care agent to have the power to donate your body for a medical study program or donate your organs, you will initial both lines. They would look something like this: “JS (Initials) My health care agent will not have the power to make a disposition of my body for use in a medical study program.”
In this section, you decide who has the power to make decisions about the final disposition of your body.
This could include decisions like whether your body should be buried or cremated and where your final resting place should be.
You can appoint a specific person to take care of these decisions by filling in their name, address, telephone number, and email address.
If you want your body to be buried or cremated, you will initial the respective lines.
Example: If you want your friend, Mike Johnson, to handle the final decisions, and you wish to be cremated, the lines would look like this: “JS (Initials) I want the following person to make decisions about the final disposition of my body: Name: Mike Johnson; Address: 789 Maple Drive, Atlanta, Georgia, 30309; Telephone Numbers: Home: (912) 123-4567; Work: (912) 987-6543; Mobile/Cell: (912) 789-0123; Email Address: [email protected]; JS (Initials) Cremated”
This part of the directive ensures your wishes about your body’s handling after death are respected, giving clear guidance to those left behind and preventing potential conflicts among your loved ones.
This part addresses your treatment preferences if you cannot communicate them due to your medical condition. These preferences become effective under the conditions specified.
Here you can specify under which conditions Part Two of the directive becomes effective. This means that your treatment preferences, as outlined in this section, will be followed if you’re in the state(s) you indicate.
Example: If you want PART TWO to be effective in a terminal condition or permanent unconsciousness, you will initial both lines. The lines would look something like this: “JS (Initials) A terminal condition, which means I have an incurable or irreversible condition that will result in my death in a relatively short period.”; “JS (Initials) A state of permanent unconsciousness, which means I am in an incurable or irreversible condition in which I am not aware of myself or my environment and I show no behavioral response to my environment.”
This is the core of your advance directive, where you get to specify your treatment preferences in detail.
This includes your desires regarding life-prolonging treatments, nutrition, hydration, and resuscitation.
There are three options for your treatment preferences:
If you choose this option, you are instructing your medical team to use all available means to extend your life, even if you can’t take nutrition or fluids by mouth.
Example: If you want every effort to be made to extend your life, initial the line next to the option (A).
If you choose this option, you are instructing your medical team to allow natural death to occur.
This means you do not want interventions that could prolong your life but cannot cure you, including tube feeding or hydration, except as needed to provide pain medication.
Example: If you wish for a natural death without life-prolonging treatments, initial the line next to the option (B).
This option allows you to customize your directive by indicating which treatments, if any, you want to be used to keep you alive, even if they can’t cure you.
Example: If you want to receive nutrition and fluids by tube but do not wish to be resuscitated or use a ventilator, your initials next to the options would look like this: “JS (Initials) If I cannot take nutrition by mouth, I want to receive nutrition by tube or other medical means.”; “JS (Initials) If I cannot take fluids by mouth, I want to receive fluids by tube or other medical means.”
This is an optional field where you can add additional treatment preferences, offer further guidance to your healthcare agent, or provide details about your personal and religious beliefs about your medical treatment.
The example suggests considering your stance on interventions like medications to fight infection, surgery, amputation, blood transfusion, or kidney dialysis.
Including such additional directives benefits your healthcare agent by providing more context and clarity in decision-making. It also helps your medical team to understand your values and choices better.
Example: Say you have a religious belief that prohibits blood transfusions. You might write, “Due to my religious beliefs, I do not wish to receive any blood transfusion.”
This section addresses the specific situation if you are pregnant.
According to Georgia law, the directives mentioned in PART TWO generally won’t be practical if you are pregnant unless the fetus is not viable.
By initialing this section, you indicate that you want PART TWO to be carried out if your fetus is unviable.
The directives you set in this part of the document provide clear instructions to your healthcare team about your wishes.
This is legally binding and ensures that your values and desires are respected during critical moments of your healthcare journey.
Example: If you want your previously mentioned directives to be followed even if you are pregnant, but your fetus is not viable, you will initial this line. Your line would look like “JS (Initials) I want PART TWO to be carried out if my fetus is not viable.”
This part deals with the appointment of a guardian if one is needed.
If you cannot do so, a guardian is a person appointed by the court to make decisions on your behalf.
This is an optional section; the rest of your directive will remain valid even if you leave this part blank.
You have two options in this section:
If you initial this option, you nominate the person you have selected as your healthcare agent (in Part One) to serve as your guardian.
Example: If you trust your health care agent to act as your guardian as well, you will initial this line, which might look like this: “JS (Initials) I nominate the person serving as my health care agent under PART ONE to serve as my guardian.”
If you initial this option, you can nominate a different person as your guardian. You must provide their name, address, phone number, and email.
Example: If you want to nominate your best friend as your guardian, your filled-out form might look something like this: “JS (Initials) I nominate the following person as my guardian.”; “Name: Best Friend”; “Address: 123 Friendly Street, Friendville, GA 12345”; “Telephone Numbers: Home – (123) 456-7890, Work – (234) 567-8901, Mobile/Cell – (345) 678-9012”; “E-Mail Address: [email protected]“
In conclusion, filling out the Georgia Advance Directive for Health Care is a proactive step to ensure your healthcare wishes are known and respected.
It provides a roadmap for the medical treatments you wish to receive or not receive and appoints trusted individuals to oversee your care.
The directive thus fosters clarity and peace of mind and reduces potential disputes or uncertainties about your health care decisions.