Bills in Missouri Legislature address end-of-life issues

JEFFERSON CITY, Mo. -- As the nation comes to grips with how to care for those who can't make their own decisions, Missouri lawmakers are considering a handful of proposals to address end-of-life care.

One piece of legislation was introduced Thursday, the day Terri Schiavo died after a long legal battle that ended after a court-ordered removal of her feeding tube. She had left no written instructions in the event she became disabled.

Now, Missouri lawmakers are seeking to make clear what should happen if the state again is faced with a case similar to Schiavo's. In 1990, Nancy Cruzan, a southwest Missouri woman in a vegetative state following a 1983 car crash, died at a rehabilitation center after a long legal fight that ultimately allowed her family to remove her feeding tube.

A bill by Rep. Cynthia Davis, R-O'Fallon, would bar anyone from directing that artificial food and water, such as a feeding tube, be withheld or withdrawn from a patient without a specific written directive from the patient specifically authorizing the removal.

"I was gripped by what I was watching and couldn't believe the state of Florida would let this woman die in this manner," Davis said. "I just wanted to make sure we set a standard for our state that says unless you have something in writing, there's a human assumption that you would want food and water.

"Certainly the Schiavo drama has brought to the forefront in everybody's minds, What about me and my family?"

Dr. Ann Allegre, director of medical programs at Kansas City Hospice, said she encourages people to put their wishes in writing, but wouldn't want health-care workers to be restricted if loved ones shared what they would want.

"I just don't want to get us into a legal bind where we can't honor [their wishes] unless it's written down," she said.

Two Senate bills on who makes the decision in such life-or-death matters were filed in early March but haven't had committee hearings yet, though both are expected to next week.

A bill by Sen. Charlie Shields, R-St. Joseph, sets the criteria for whom a doctor or other provider must turn to to make medical decisions if there is no paperwork indicating who should make decisions for a person who is incapacitated.

The bill would require that doctors turn first to the person's spouse, then a grown child, then a parent and then a sibling.

Another bill, by Sen. John Loudon, R-Ballwin, spells out that when no paperwork indicates a patient's choice in treatment, the courts must grant custody to someone who is willing to continue the patient's care.

End-of-life issues have generated much attention beyond the Capitol as well. Attorney General Jay Nixon compiled a brochure and documents for living wills and health care choices directives last year, and his office said Friday that it has gone from receiving hardly any requests for the information to fielding 200 calls a day. The office is not even tracking those who download the information from the Web site.

"Even though it was tragic down there, if there's some good that can come out of that case, it's causing us to think through what we're doing here," Davis said.

Gov. Matt Blunt believes Missouri law is sufficient, spokeswoman Jessica Robinson said, adding it's too early to say if he would sign any of the legislation.

"He feels there really is no change necessary at this point to ensure the presumption is in the favor of life," she said. "Existing Missouri law is very clear."