Living will interest emerges from life-or-death struggle

Saturday, March 26, 2005


* Power of attorney:

* Living will:

* Advance directive:

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By Bob Miller ~ Southeast Missourian

The life-and-death controversy surrounding Terri Schiavo has clearly touched off some strong emotions throughout the country.

But regardless of one's position on whether Schiavo's feeding tube should have been removed, experts agree that the family feud, the court fights and the political bickering could have been avoided if she had had a living will.

The case has put an emphasis on advance directives, which include living wills and powers of attorney, which allow someone trustworthy to make a patient's health decisions when that person is declared brain dead.

Local medical officials and lawyers say such documents are simple to draft and can prevent a lot of headaches for family members.

In Cape Girardeau, hospital workers ask their patients if they have living wills and then can provide documents if they don't.

Dan Berry, the vice president of legal affairs for Southeast Missouri Hospital, recommends not just a living will but a durable power of attorney.

Berry recommends living will and power of attorney examples that can be found on the Missouri Bar's Web site and that these forms, which don't require hiring a lawyer, are good enough for most people.

Those documents point out that living wills generally apply only when a person is expected to die in a short period of time and do not allow for the withdrawal of artificial nutrition and hydration. They do not cover situations where a person is in a persistent vegetative state.

Cape Girardeau lawyer Craig Billmeyer said living wills or powers of attorney "are incredibly important for single surviving parents and individuals who have no children."

Berry said several times a year family members at the hospital disagree on what extent of care should be provided to a relative.

"For instance, let's say we have a single elderly woman who is mentally incapacitated and she has adult children scattered across the country," he said. "And the children all have different degrees of communication throughout the years. Some believe she'd want everything done to keep her alive, another one might say, 'She told me at a family reunion 10 years ago she'd never want to be kept alive artificially.'"

Berry said in such cases, the hospital gets the family together to talk with the patient's physician, particularly if there has been a longstanding relationship. If a decision can't be reached after consultation with the physician, the hospital looks to the next of kin.

If there is no kin, "the Missouri law would be, like President Bush has said, to err on the side of life," Berry said.

The forms on the Missouri Bar Web site come with step-by-step instructions.

People may chose to accept or deny feeding tubes, surgery, artificial resuscitation, antibiotics, dialysis, mechanical ventilator, chemotherapy and radiation therapy on the condition they are "persistently unconscious" and have "no reasonable expectation" of recovery from a "seriously incapacitating or terminal illness or condition."

Those who wish to donate their organs should be particularly careful to express their wishes to their family, said Breita Church, donation specialist with Mid-America Transplant Services.

There are two important things to remember about organ donation when filling out powers of attorney.

First, a body must be kept on a ventilator for 12 hours to 15 hours after the person is considered brain dead for the organs to be viable.

Second, a power of attorney for health can only speak for a person until that person dies and not after, she said.


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