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July 15, 2006 So you've written out your wishes for end-of-life care in a Living Will, and designated a surrogate in a Power of Attorney for Health Care. Whew! At least you don't have to worry about that any more. Wrong! What if your doctor does not agree with your choices, or the medical facility does not want to honor them? What if your surrogate caves in to your child's wishes, even if they don't match yours? What if an unrelated third party intervenes, say the Governor? With the recent focus on Terry Schiavo's case in Florida, the Supreme Court not overturning the Oregon law passed by voters, and the California legislature debate about legitimating assisted dying, people have been flocking to web sites and lawyers to fill out forms. That is important, but it may not be enough, and far too many people never document their wishes at all. You need to know that unless your doctor enters the information directly into your medical chart, written documentation may be meaningless. In addition, statistics indicate that when patients are in nursing homes, they are more likely to end up in a litigated process, in spite of state laws clearly allowing surrogates to request withdrawal of treatment. The law in Florida gave clear authority to Schiavo's husband, but that did not prevent years of fighting with her family in court. Because end-of-life decisions are controlled by state law, there are 50 different standards. Documentation acceptable in one state may not be honored in another. There is no national registry, so if you are traveling you may be out of luck. Having worked in this field for over 20 years, I have developed some practical suggestions, based on the experience of others and various court cases, that can help ensure your end-of-life choices will be honored. They include: 1. Discuss these issues well before it becomes necessary. It's never too early to make your choices known, and you can prevent the kind of conflicts that can split families apart and prolong the dying process. 2. You need a Living Will, documenting your wishes, and a Power of Attorney for Health Care, naming a surrogate who will make medical decisions for you if you are unable. Consider naming someone other than your spouse or one of your children – a good friend, your family attorney, or a relative like an aunt or cousin is more likely to withstand emotional pressures and fulfill your clear intentions without guilt. 3. Communicate your choices clearly and often to family, friends, doctors, and anyone else who could later verify that you made your wishes known in the event your situation ends up in court. 4. Verify that your doctor will honor your wishes. If not, find another doctor. Or instruct your surrogate that if the time comes when your wishes come into play, you want to request an attending physician who will respect your choices. 5. Be specific enough to make clear when and under what circumstances you do not want your life to be artificially sustained. But don't be so specific that any condition or situation that does not match exactly what you have defined could be considered not covered. Conversely, if you want life sustained against all odds and at any cost, be clear about that. 6. Update documents frequently enough to keep your decisions current, at least every five years. Courts often overrule documented choices if they were made too far in the past. 7. When traveling, carry with you either a small card or a copy of your documentation indicating you have an advance directive, including contact information for your surrogate. No one wants to think about or discuss dying. We all tend to deny our own mortality until it is upon us. However, the question of "Who decides?” is one we cannot avoid if we want to have some control over our end-of-life circumstances. The right to refuse treatment is constitutionally protected, but if you cannot effectively exercise it, it might as well not exist. ------------ About the author: ANITA RUFUS, J.D., is a long-time constitutional rights activist, and Past-President of Americans for Death With Dignity, sponsors of Proposition 161, the "California Death With Dignity Act," on the 1992 ballot. Rufus received her J.D. from California Western School of Law, and is a Credentialed Mediator specializing in end-of-life choice conflicts. For more information, see www.thelivingendbook.com. Email: ANITARUFUS@aol.com Comment on this article here! ------------ All articles are EXCLUSIVE to Useless-Knowledge.com. Please link to this article rather than copying and pasting it onto your site (which would be unauthorized and illegal). |
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