Hospitals to revise living will system

BayCare will offer a standard form to be sure dying patients get only the treatment they want.

By WES ALLISON, Times Staff Writer
© St. Petersburg Times
published February 28, 2002

To help dying patients get only the treatment they want, a group that advocates better end-of-life care will provide a standardized living will to hospitals in the BayCare Health System.

The arrangement with Project GRACE, approved last week by BayCare's ethics council, follows a national trend toward providing standard living wills that are considered "portable," working from hospital to hospital or even state to state.

Project Grace's living will, which it calls an "advance care plan document," is a form on which people check off what level of care they would want in various circumstances. The idea is that doctors will become familiar with the standardized form, reducing the chances for confusion regarding a patient's wishes.

"It will certainly help our patients in trying to have their living wills honored," said Sister Pat Shirley of the BayCare Ethics Council, which includes members of the ethics councils of each of system's five hospitals.

The document will become part of the patient's medical records and will be kept electronically, so it will be recognized at any BayCare hospital, she said.

Federal law has required hospitals to offer a living will form to all patients since 1991, but this one is much more specific than most. The detailed form allows patients to choose treatment options for a variety of conditions, including persistent unconscious state, permanent confusion, total dependence and end-stage disease.

It also allows for patients to designate someone who can make choices about their health care.

Dr. Lofty Basta, a Clearwater cardiologist and chairman of Project GRACE, said living wills frequently aren't honored, and often that's because they are vague. For example, many people ask that care be withheld when they have an "irreversible illness."

However, he said, that wouldn't cover a patient with advanced-stage Alzheimer's disease who develops pneumonia and has to be put on a ventilator to survive, because pneumonia is reversible.

"When you have a document that is subject to interpretation . . . the family members almost always err on the side of caution. Physicians almost always lean on the side of caution," Basta said. "So the living will ends up not fulfilling its purpose."

Experts say it's best to fill out a living will before you get sick, and you should discuss it with your family, your doctor and your clergy. Anyone can get the document from Project GRACE, via phone or the Internet.

Shirley said all patients of BayCare hospitals eventually will be offered the Advance Care Plan Document, probably in one or two months.

BayCare the is region's largest hospital system and includes St. Anthony's in St. Petersburg; Morton Plant in Clearwater; St. Joseph's in Tampa; South Florida Baptist in Plant City; and North Bay Hospital in New Port Richey.

Basta said Project GRACE, which stands for Guidelines for Resuscitation and Care at End of Life, is discussing similar arrangements with other bay area hospitals.

A national group based in Tallahassee, called Aging with Dignity, has launched a similar effort with its own standardized living will, called Five Wishes. President Paul Malley some 3,500 organizations are using it, including 400 hospitals.

"What we hear from doctors is they don't want to be put in a situation to have to make the decision, or to referee disagreements with families," Malley said. "It's good to have it down in writing."

Interested?

You can print out a copy of the "advance care plan document" from Project GRACE's Web site, www.p-grace.org. Or call 1-877-994-7223 to request a copy.

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