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Living Wills: Everyone Ought to Have One

The case of Terri Schiavo -- the brain-damaged Florida woman at the center of a 7-year legal battle over her right to live or die -- is sparking new public interest in a document called an advance directive, better known as a living will. Most Americans don't have one. But now, that might be changing.

Terri Schiavo was 26 years old when a heart attack damaged her brain and left her in what doctors have called a persistent vegetative state - alive but unable to think or communicate. It is not surprising that the young woman did not have a legal document stating her wishes in the event of a life-threatening medical emergency. Most people -- especially young people - prefer not to think about death or dying, or what might happen should they become incapable of speaking for themselves. But many legal and health-care professionals say they are busier than ever since the Schiavo case took center stage recently in the news media.

Kathy Brandt, who is vice president for the National Hospice and Palliative Care Organization, an advocacy group for terminally-ill patients and their families, says the number of people requesting information has increased dramatically. "We've been getting a lot of phone calls," she says. "Right now we're experiencing about 4 to 5 e-mails a minute from people who are requesting information about advance directives."

Kathy Brandt says national statistics suggest that between 25% and 40% of Americans have a living will. The legal document, which is recognized by states, specifies the sort of measures to be taken - or not taken - to treat a person in the event of a catastrophic accident or illness. Ms. Brandt says it's easy enough for anyone to obtain a form from their state government, and some kinds of living wills are available online. But she says the language of the wills may vary from state to state.

"For instance," she says, "some state advance directives offer choices such as 'Would you want artificial nutrition, hydration, or would you want CPR or would you want to be hooked up to a ventilator?" Ms. Brandt says some forms are very specific, others are less detailed. "(They might say), 'Would you like heroic measures?'" she adds. "And they usually give a place where people can write down any specific requests that they have."

Camilla McCrory is an elderlaw and estate attorney in Maryland. She says she is not in favor of do-it-yourself will preparation. Depending on the state, she says, some wills can be difficult to complete. "Forms don't work terribly well.," Ms. McCrory says, "They're very confusing, they're 'check-box,' fill-in-the blank kind of thing." Commenting on a study done by the University of Maryland Law School, the attorney says, "The percentage of forms that were incorrectly completed by the citizens of Maryland was quite high. They contradicted themselves internally, thereby rendering the document almost useless."

Ms. McCrory says she thinks a more useful document is called a medical directive health care power of attorney. The document is prepared by a legal professional and designates one individual to speak on a person's behalf in the event they become incapacitated. Or in other words, as Ms. McCrory explains, the document says: "'I'm giving the power that I have right now to make all my decisions for myself to another person. I keep all the power to myself as long as I have capacity. But when I don't have capacity, I trust this person to do what I would do were I able to." She adds, "The living will is static because it just sits there and it says, 'If I am terminally ill then I want this or I don't want that.' It tends to be much more limited."

Hospice executive Kathy Brandt says the Terry Schiavo case would have been far less complicated had there been a health care power of attorney already in place. "In the state of Florida," Ms. Brandt says, "the law clearly states the order of people who can speak for you if you don't have someone specifically appointed. And in Florida the first person it defaults to is the spouse."

Whether one prepares a living will from a state government or from an estate attorney, the consensus among legal professionals is that everyone should ensure that their wishes for end-of-life care are clearly described for the families and loved ones who will have to carry them out.