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The Terri Schiavo Case

The Terri Schiavo Case Q&A

The Times has previously published the following questions and answers, culled from social workers, hospices, physicians, attorneys, clergy and others.

By Times Staff
Published October 22, 2003

Q: How do I take steps to ensure my wishes are followed?

A: Make your wishes known. Typically, a person uses advance directives - oral and written instructions about medical care. The instructions are recorded in a living will or a medical power of attorney.

A living will informs doctors and family members about the kind and extent of care you wish to receive should you become terminally ill and unable to speak for yourself. Instructions may be general or specific and may include or reject treatments. They can also specify length of treatment, such as how many days you're willing to breathe on a machine before you want someone to disconnect it.

Experts also recommend that you execute a medical power of attorney, also called a health care proxy. This document appoints a person to make medical decisions for you. The advantage of a proxy over a living will is that your surrogate can deal with situations you may not have anticipated. In many states, the proxy can step in any time you are incapacitated, not just at the end of life.

Q: What procedures should I consider in deciding what I do and do not want done?

A: The use of a respirator, cardiopulmonary resuscitation, surgery, blood transfusions, feeding and hydration tubes inserted through the nose or surgically in the stomach, intravenous hydration, antibiotics, chemotherapy, dialysis and diagnostic tests.

Q: What if I want a treatment or life support stopped?

A: The law makes no distinction between failing to start an unwanted life-support procedure and withdrawing one. Emotionally, withdrawal is much more difficult for loved ones. Those deciding to put someone on life support should consider that the patient could live, without improvement, for years.

Q: Do I need a lawyer?

A: No. But a lawyer can help with end-of-life planning, from picking a medical surrogate to who gets Grandma's china.

Certain people may need a lawyer more than others. Unmarried couples may want to take steps to prevent a blood relative from bumping one or the other as the responsible party. Traditionally, spouses, parents or adult children are the next of kin consulted by caregivers.

Q: Is a living will binding?

A: A living will is neither an edict nor a guarantee.

Health care providers usually heed the wishes of a relative over those of a comatose, dying patient. Loved ones may take actions which contradict your wishes.

In many states, a living will cannot be honored if a woman is pregnant.

Q: What if I have nothing in writing?

A: While oral instructions or conversations with a physician or family do not have the same legal weight as written documents, they are evidence of your wishes.

Generally, the next of kin will decide what should be done. A wife, for example, would be legally responsible for making decisions for her husband.

Surprisingly, many designate a proxy without telling the person, who has no inkling of what the patient wants.

Q: Can I trust my doctor to do what I want?

A: Ideally, you and your physician have discussed your wishes. Your doctor has answered questions about different procedures: what they are, when they are used, how they may hurt as well as help. He or she has a copy of your living will.

Doctors' attitudes about living wills are changing. Still, there are many cases in which physicians have intervened despite the written objections of the patient. Medical personnel may fear being sued if they don't intercede. If they do, they could be taken to court for medical battery for forcing treatment on an unwilling patient.


Making a living will

1. Obtain a form which meets Florida's legal requirements (those issued by Florida agencies should) and compare it to others so you can tailor it to your needs.

2. Discuss the issues in the document with family, friends, clergy and your doctor. Clarify your values and wishes. Ask about medical procedures you don't understand, and why and when they might be used. Ask the people you will count on if they're willing to make these choices.

3. Complete the form. Cross out or add statements to suit your needs. Make certain the witnessing is done correctly.

4. Distribute copies to family, friends and your doctor. Review annually to ensure it reflects your desires, and initial and date it. If significant changes are made, the safest course is to collect the previous document and replace it with a new one.

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