Anniversary of Terri Schiavo Death Reminds Us of Need for Advance Directives

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Making plans for what we would like done in the case of a life-threatening health care crisis is not something most people wish to think about. Often, people take the “Scarlett O’Hara” approach and say, “I’ll think about that tomorrow.” March 31st marks the fifth anniversary of the controversial death of Terri Schiavo. Had she put her wishes in writing, perhaps the hurt her family still feels could have been avoided.

Terri Schiavo suffered cardiac arrest at her home in 1993 and fell into a vegetative state. Although considered “brain dead”, her body was kept alive through the use of a feeding tube that provided nutrition and hydration. Her husband, Michael, insisted that she had voiced her desire not to have her life prolonged by artificial means, her parents disagreed because there were no written documents, leading to a legal battle that finally ended in March 2005. She died on March 31st of that year.

Today, health care and hospice professionals hope to use Ms. Schiavo’s story to bring awareness to the need for all Americans to prepare advance health care directives so that our loved ones know what our decisions are in the case of a crisis that leads to the end of life. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, says, “It doesn’t matter whether you want every medical intervention available up until the day you die, or whether you want to spend the final period of your life receiving what many call ‘comfort care’ – it should be your decision.”

One of the reasons many delay making the decisions is the confusion over the terms and options that are available.

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Advance directives are written instructions regarding your medical care preferences. Any person over the age of 18 can have an advance directive document. These include three major types of documents:

• Living will – this written, legal document specifically spells out the types of medical treatments and life-sustaining measures you do or do not want, such as mechanical breathing (respiration and ventilation), tube feedings, or resuscitation. These may also be called health care declarations or health care directives.
• Medical power of attorney (POA) – The medical POA designates an individual, referred to as your health care agent or proxy, to make medical decisions for you in the event you are unable to do so. It may also be called a durable power of attorney (DPA) for health care. It is different from the type of POA that authorizes someone to make financial transactions for you. The person you choose does not necessarily have to be a member of your family, but should be someone with your best interests in mind.
• Do not resuscitate (DNR) – the DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops beating or if you stop breathing. This document will be placed in your medical chart in the case of an emergency.
• Organ donation – this document is not necessarily part of the advance directives package, but it is something that can be noted as a part of your overall desire for what you wish to have done with your body at the end of your life.

Advance directives do not have to be complicated documents and can be written in several ways, but must comply with state laws. Your doctor, hospital, health department, department on aging, or lawyer can supply a form that can guide you into making the best decisions that reflect your desires for end-of-life care. Hospice also offers the “Physician Order for Life Sustaining Treatment” and their “Five Wishes” document. There are also computer software packages available. When you are satisfied with the directives, the orders should be notarized and copies given to your family and all physicians involved in your care.

You may change or cancel your advance directive at any time, as long as you are considered of sound mind to do so, meaning that you are still able to think rationally and communicate your wishes in a clear manner.

The National Healthcare Decisions Day will be observed in many communities on April 16th. Encourage your friends and families to think about this very important action, because health care emergencies can happen at any time.

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Comments

1. No one ever diagnosed Terri as 'brain dead' 2. An advanced directive would not have changed the civil battle because it was not legal to take medically assisted food and fluids from a non-dying patient in Florida when Terri was still competent to commit to an advanced directive. 3. Terri's was not an 'end of life' case. The Medical Examiner stated she could have lived many years more -- had she not been dehydrated to death. 4. You can NOT change your directive at any time. Research the case of Marjorie Neighbert and you'll see that this is wholly incorrect. Seriously. If you're going to write about things, you might want to do a bit of schooling yourself first.
Be careful that you follow state laws in completing these documents. For example, the mentioned POLST and 5 Wishes are not legal in the state of Texas. Also, several states (such as Texas and Nevada) require that ADs follow statutory language. In Texas, the sound mind requirement applies only to creating the AD, not to rescinding it. One should also note that not all states all an AD to be notarized--some states only accept witnesses.