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Case has created sudden interest in living wills

Published March 26, 2005

CLEARWATER - The debate over Terri Schiavo's wishes has brought a flood of national attention to living wills. But a legal document simply expressing the wish to cease "life-prolonging procedures" may still be too vague to ensure that some medical professionals remove a feeding tube.

"I think that has been the central issue in this whole case, whether (a feeding tube) is really life support," said Mark Brandt, a Dunedin lawyer who specializes in estate planning.

A living will is a legal document informing doctors and family members about the extent of care patients want to receive should they become terminally ill and unable to speak for themselves.

Schiavo did not have one, and the result has been a disagreement between her parents and her spouse over her wishes.

But lawyers familiar with living wills say just having a living will may not be enough. Not all such documents answer crucial questions - specifically whether or not a feeding tube should be removed under certain circumstances.

Bruce McManus, a Largo lawyer who specializes in elder law, said some doctors fear being accused of murder for taking out a feeding tube without the support of a legal document.

"If there were any way to interpret it ambiguously, they would interpret it ambiguously and not cooperate," McManus said.

Last year, Pope John Paul II said feeding and hydrating patients in a persistent vegetative state is morally obligatory and called the removal of feeding tubes "euthanasia by omission." U.S. Catholic hospitals responded by telling patients they would respect the wishes outlined in a living will.

McManus and Brandt both include specific language on feeding tubes in the living wills they draft.

"Because of (the Schiavo) case, I think people have heightened sensitivity to the feeding tube," Brandt said. "But the next case might have some other type of medical intervention, and then we'll have to start looking at that."

Brandt said he wouldn't be surprised if the Florida Legislature revisits the subject, perhaps asking those who draw up living wills to specify the patient's wishes regarding their removal of a feeding tube.

Attorney General Charlie Crist said his office has reviewed the state law and, at this time, does not think more specific language on feeding tubes is warranted. He said the degree of detail should be left to the individual.

"Obviously, the more specificity, the less that is left to question," Crist said. "And you wouldn't have one of these gut-wrenching situations, like we are dealing with right now."

Advocates for living wills say that thousands of people once unfamiliar with the legal document are asking questions about them.

"We are overwhelmed," said Dr. Joseph Barmakian, founder of the U.S. Living Will Registry.

The registry is a private organization in New Jersey that electronically stores advance directives, organ donor information and emergency contact information, and makes them available to health care providers across the country 24 hours a day through an automated system.

Barmakian, an orthopedic surgeon, said the Web site traditionally has 500 hits a day. This week, it has had more than 30,000 on some days.

The organization has more than 20,000 living wills on file. Barmakian estimates that 25 to 30 percent of adults have one.

"It is a tremendous response," Barmakian said. "The only positive thing that has come out of this whole episode is the need to discuss and have a document."

Brandt said having a living will makes sense for anyone.

"I think the general public should consider having something in writing," said Brandt. "This case proves that. And the more specific it is in addressing these different conditions, the better off it is."

- Michael Sandler can be reached at 445-4162 or

[Last modified March 26, 2005, 01:09:10]

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