01:00 AM EST on Wednesday, March 23, 2005
01:00 AM EST on Wednesday, March 23, 2005
Put care choices in writing, experts urge
BY EDWARD FITZPATRICK
Journal Staff Writer
PROVIDENCE -- What do most Rhode Islanders have in common with Terri Schiavo?
According to a state officials, it's that they've never discussed or documented
the kind of medical care they'd want if they were ever seriously ill or injured.
President Bush, Congress and the federal court system are taking part in a
bitter debate about whether Schiavo, a brain-damaged Florida woman, should be
kept alive with a feeding tube.
And the high-profile case is focusing on the importance of having a living will
or designating someone to make health-care decisions when you can't, according
to the state attorney general's office and a doctor who has just made a film on
the subject.
"If Terri Schiavo had made her intentions known in writing, the tragic fight
we're watching for control of her fate would have been avoided," Attorney
General Patrick C. Lynch said yesterday.
"Regardless of what side of the Schiavo case you take," said Assistant Attorney
General Maureen G. Glynn, the state's health-care advocate, "the main point is
to talk with your loved ones about what you'd want for medical treatment if you
couldn't make decisions yourself -- and to document it."
The necessary documents are easy to get, they're free, and you don't need a
lawyer to fill them out, Glynn said. Yet, she said, most people have never
filled them out.
"Americans think they are going to live forever," she said. "They don't like to
think in these terms."
Dr. Joshua Kreiss, a Brown Medical School graduate who just released a film
called Advance Medical Directives: Something to Think About, estimated that
less than 10 percent of the patients he's seen in hospitals have documents
spelling out what kind of treatment they want to receive.
Wealth is a good indicator of whether you have such documents, Kreiss said. "If
you are rich and you can afford a lawyer, you are more likely to have some
advance directive included in your estate planning," he said.
Lynch said many people wait until they're older and heading to a nursing home
to inquire about those documents. But, he said, "The end of life is not as
convenient and doesn't come in the time many expect it will."
Kreiss said, "Do you think Terri Schiavo at 26 expected to suffer from heart
failure and spend 15 years in a persistent vegetative state? I've seen many
cases that began with an unexpected visit to the emergency room and evolved
into a prolonged stay in the intensive care unit."
There are two types of "advance directives" in which patients spell out their
health-care wishes: a living will and a durable power of attorney for health
care.
Glynn said living wills allow people with terminal conditions to direct whether
they receive feeding tubes or other forms of life support, and the durable
power of attorney for health care lets people appoint a "health-care agent" to
make decisions for them when they cannot participate in the decision-making
process.
Glynn described the power of attorney for health care as a more flexible
document, noting it's not limited to people with terminal conditions. Kreiss
agreed, saying, "The more practical things for doctors and patients is to have
someone to stand in for them who knows their end-of-life wishes."
Glynn said the health-care agent should be someone you trust. "They are going
to have power over your life," she said. "They should understand it's what you
want done."
Kreiss and Glynn agreed that the key is to get people to talk to people they
love about health-care issues. The durable power of attorney form suggests
questions such as: "Do you think life should be preserved for as long as
possible? Why or why not?" and "Would you want your pain managed, even if it
makes you less alert and shortens your life?"
People don't have to use any particular form to create these documents, but the
ones offered by the state will be recognized by health-care providers.
People with computers can go to the state Health Department Web site to
download forms for a living will or durable power of attorney for health care,
or they can go to the attorney general's Web site for a durable power of
attorney form in English and Spanish. People without computers can call the
attorney general's office at (401) 274-4400, ext. 2316. The durable power of
attorney for health-care form is also available through the Department of
Elderly Affairs.
Lynch cautioned Rhode Islanders against anyone trying to sell the form, saying,
"Any high-profile story encourages unscrupulous people to try to cash in."
Residents 18 or older can fill out the forms. The form must be signed in the
presence of two qualified witnesses (not your health-care agent or doctor, for
example), or the signature can be notarized.
Glynn cautioned against putting the completed form in a safe-deposit box, where
it'd be unavailable if someone ended up in the hospital on a Sunday. Rather,
she suggested giving copies to health-care agents, doctors, family members and
lawyers.
Kreiss said family conflicts can erupt if there has been no discussion or
documentation of what kind of care a family member would want, and the
intensive care unit can be a "horrible, painful place" to have that discussion.
When asked when people should fill out the forms, Glynn said, "Yesterday."
Digital Extra: Find out more about living wills and power of attorney for
health care, plus sample forms, at:
http://projo.com/extra/2005/livingwills/
http://www.projo.com/news/content/projo_20050323_wills23.25a9c00.html