Keep Your Health and the Care You’ll Receive Under Control

Do you know who would make decisions regarding your medical care if you were unable to do so? If this is something that worries you, you are not alone.

Complex or conflictive family relationships, as well as an increasing amount of people living alone, have caused young and older adults to worry about who will make medical decisions on their behalf if an accident or illness were to leave them unconscious and without the ability to express their wishes.

Advance directives: A solution

“Advance directives or living will is a simple legal document through which you can clarify who and what type of decisions can be made about your health care if you become unconscious, fall into a comma, or are rendered unable to make decisions for yourself,” explains Ms. Dalila Allende, the Corporate Ethics and Compliance Director at Triple-S.

Allende provides orientations on legal topics as part of Triple-S’s Contigo Cuidador initiative. This is a frequent topic in conversations with workshop participants.*

What are its benefits?

“There are multiple benefits. You make sure that your wishes will be respected, you simplify decision making during a critical moment, healthcare providers will know who to contact when asking for authorizations, and you diminish the possibility of family disputes in a time of crisis. Moreover, not everyone in a family has the same values and beliefs, which complicates decision making and may cause conflict,” affirmed Allende.

What should we take into consideration?

You must consider your values. For instance, how important is your independence and self-sufficiency to you. Do you want that all possible measures be taken, including prolonging your life even if you’re in an irreversible vegetative state?

Although it’s difficult to predict the medical circumstances one could face, it is advisable to have an honest conversation with a trusted doctor about the most common life-prolonging treatments. Learning about these procedures will help you make an informed decision.

Some of the treatments you may refuse or accept under certain circumstances specified by you are:

• Cardiopulmonary resuscitation (CPR)
• Mechanical ventilation
• Dialysis
• Use of antibiotics and antivirals
• If you wish to be an organ and tissue donor

However, there are certain processes which you won’t be able to arrange. For instance, if death is not imminent, a healthcare provider will continue to provide hydration and nutrients to your body while it can absorb them. In addition, if it’s a painful condition, medications will continue to be administered to ease the pain. 

It’s important to know that if the person executing the living will is a pregnant woman, the directive will be valid after she gives birth to protect her unborn child or children. You can also designate someone to represent you and make decisions on your behalf when you are unable to do so. This is important because, even though the advance directives can be highly specific, it’s impossible to anticipate all possibilities. Moreover, it’s always convenient to have someone who can represent you.

Who should be my healthcare agent?

First of all, it should be a person you trust. The person should also:

• Know your wishes and be willing to make decisions in a terminal condition scenario.
• Be able to defend your wishes when differences between your loved ones arise over what your medical care should be.
• This person can be your spouse, partner, friend, or a family member. You could also name alternate agents in case your designated agent is unable to perform their role.

Allende emphasizes that this type of decision should be reviewed frequently. “For instance, when there are changes in your life, such as a divorce or family conflict, it’s advisable that you review who will be your agent.” 

How to prepare advance directives and the requirements you must meet

In Puerto Rico, any person 21 years of age or older can express their preferences regarding the medical treatment they wish to receive through advance directives. The following requirements must be met:

• You must be at least 21 years of age and of sound mind.
• You don’t have to be ill to draw up a living will.
• You can execute a certificate or affidavit before a notary public or person authorized by the Government of Puerto Rico to authenticate signatures.
• You can also make it before a doctor and two witnesses who are not your potential caregivers or your heirs.

Once you have your advance directives, you should provide a copy to your doctors and service providers, such as hospitals.

And what if I change my mind?

You can change your mind at any time and the only thing you must do is draw up a new document. It’s recommended that you include a clause indicating that all previous documents are revoked. Submit a copy of the new document to your healthcare providers and ask them to revoke the previous one.

*To learn about the Contigo Cuidador initiative workshop calendar, visit