Bioethics Discussion Blog: Schiavo Case: Would an Advance Directive Helped?

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Tuesday, March 22, 2005

Schiavo Case: Would an Advance Directive Helped?

In these past few days with all the discussion about the Schiavo case, I have noticed a huge avalanche of advice from various sources to the public. The gist of the advice is: Better write an advance directive or you might end up in a mess like Terri Schiavo. The advice seems to be taking off, at least based on what I hear on radio and TV interviews with your average Joe and Jane on the street. But is the public getting fully informing information about advance directives? Not that I can tell.

There are two components of many advance directives: there is a living will portion which states, usually not in the patients own words, what the patient wants done under conditions where there is no hope for recovery from a life threatening illness. If it simply a check off box---that is bad! Better write it out what you want in your own words in your handwriting or dictate it to your lawyer who might help you with some of the wording. Best of all, talk out your wishes with you own physician. You will learn a lot more about the possibilities but unfortunately not all. More later about that. The second portion is the assignment of a person designated as a Durable Power of Attorney for Healthcare. Unfortunately, many folks are satisfied with the living will portion and fail to select that important person.

Now I will tell you why a designated Durable Power of Attorney for Healthcare should be identified. Think this out. Someone writes “I don’t want any life-support if I have a terminal illness and am unable to communicate.”. This is written years earlier when the patient is healthy and has no idea of what the terminal illness will be and what is the life-support that would be used. Further, does this mean that if the patient had HIV (a potentially terminal illness but the patient is now stable except for a mild infection for which an antibiotic was prescribed) would he want intubation and attachment to a ventilator if he had an acute anaphylactic reaction to the antibiotic? The ventilator treatment would be often just temporary and prevent death from the lack of oxygen because of the allergic reaction. Could this be interpreted by the patient’s physicians and the courts as to exactly what the patient would really want when the patient becomes ill? What I am trying to explain is that the words in an advance directive can be confusing as to what really were the desires of the patient if the patient was full aware and informed about the patient’s current condition. There also may be missing from the advance directive important details about the patient wishes: the patient’s value, goals and the degree of quality of life the patient would want to live with after the acute phase of the illness is resolved and some residual abnormalities persist.

All of this ambiguity can be more readily resolved if the patient has selected a legal surrogate, has spent time talking with the surrogate about values, goals and quality of life desired and any other personal factors the surrogate should consider. Now, when the patient is ill and unconscious and can’t make medical decisions at the time, the legal surrogate (the person named as surrogate as the Durable Power of Attorney of Healthcare) can now act in the patient’s place. The legal surrogate is informed by the physician about the clinical situation and the treatments and then can make an informed consent or dissent based on the surrogate’s knowledge of the patient’s wishes. The legal surrogate can also interpret, in light of the current known medical information, the wording of the living will portion of the advance directive. In addition, the legal surrogate can make the many medical decisions about accepting tests or treatments not specifically related to life support.

Remember, unless our Congress and our President change the laws now in existence or there is clear evidence that the surrogate is not considering the patient’s interest but considering only the surrogate’s own self- interest or is mentally incompetent at the time, a person who is the Durable Power of Attorney for Healthcare “speaks” with virtually as much clout as the patient. Note that a person at the top of a nominal potential surrogate list including a spouse may not be given the same legal power in directly speaking as the patient compared with a court-appointed conservator or the patient selected Attorney for Healthcare.

I hope this explanation of the need for at the least a designation of a legal surrogate by the patient is helpful. With regard to the answer to the question in the title of this posting, an advance directive for Terri probably and sadly would not have helped once the case moved from a personal family issue to a political issue. ..Maurice.

6 Comments:

At Wednesday, March 23, 2005 6:26:00 AM, Blogger Bioethics Dude said...

and it doesn't take long to do a living will or a DPAH; one can do it over half a day with their folks--my mum and I wrote one up several weeks ago.

 
At Sunday, March 27, 2005 10:58:00 PM, Blogger chromazine said...

Even though it is supposedly easy to do a living will you are right it isn't. Most of the default one's are written in the default mode of "shut things off I don't want to live" for some bizarre reason.

So you are right spelling it out is most important and in full glorious detail in your own words and maybe even hanmdwriting. I mean I dunno has a blog been ever used as an a directive to say "Keep Me Alive pretty much no matter what?" or "If I have a Cortex+Limbic System please keep me alive? which is what mine bolil down to.

Have Fun,
Sends Steve

 
At Monday, March 28, 2005 7:30:00 AM, Anonymous Anonymous said...

Although I already have a living will, I am considering adding a videotape of myself so that any idiots that might want to "save" me can see how adamnant I am against being on a feeding tube for 15 years! Do any of these people REALLY think that Terry Schiavo would want to "live" like this?! Damn!#*
Mike in Michigan

 
At Thursday, March 31, 2005 2:39:00 PM, Anonymous Rob Muster said...

what law?

WHEN did any Congress pass a law
allowing and regulating euthanasia?
WHAT STATE passed a law making euthanasia lawful?
WHEN did it become NOT Murder to STARVE and DEHYDRATE someone
who is incapacitated (permanently or not)
to the point of DEATH ..???
WHERE are all of these laws written, that we may go read them?
after all, ignorance of the law is no excuse, no ..???
what acts of Congress or of the State Legislatures enabled
euthanasia to be a legal process ..???
where is the law that says a husband has a RIGHT to DEMAND
his wife be put to death, incapacitated or not ..???
even WITH "patient's explicit written consent" what LAW
says that a Doctor can facilitate death by starvation
and dehydration ..???
if starving and dehydrating someone to death is so EUPHORIC,
WHY do we have so many OVERWEIGHT people ..???
have YOU ever tried going even TWO FULL DAYS without
food and water ..???
(bet ya CAN'T)

starvation and dehydration have LONG been "tools" used by
leftist socialist totalitarian governments and tyrants
to commit GENOCIDE ..!!!

Terri Schindler Schiavo has now died after 14 days
of FORCED STARVATION without food and water ..!!!
THAT is JUSTICE and "rule of law"? NO ..!!!
it is rule by JUDGE ..!!!
it was an execution based on HEARSAY ..!!!

paraphrasing Abraham Lincoln,
'those who deny food and water to others,
when it is in their power to provide it,
deserve it NOT for themselves,
and under a JUST God, will not long retain it.'

"Do unto others, as you would have others do unto you."
THAT IS THE LAW,
REGARDLESS of ANYONE'S opinion
whatever you SOW, THAT IS EXACTLY what you'll reap.

 
At Thursday, March 31, 2005 7:21:00 PM, Blogger Rand Kluge said...

My wife has multiple sclerosis. From the time she was first diagnosed in 1981, she lived quite normally. But today, after an extremely admirable race against this relentles disease, she propels her body through life in a power-chair. She has lost the use of both of her legs and her left arm. She manages the best she can with partial use of her right hand.

I am her care-giver. If I don't feed her, she doesn't eat. If I don't give her water, she doesn't drink. If I negated her access to food and water, she would die. Without the sanction of a federal judge to refuse her food and water, I would be prosecuted and sentenced as a MURDERER in the eyes of the law.

So, I guess it's O.K. now in America to commit genocide under judicial order.

Hmmm.....Think I'll disguise myself as a Frenchman.

 
At Sunday, April 03, 2005 9:34:00 PM, Blogger Maurice Bernstein, M.D. said...

To Rand: First, I want to say that I admire your being her care-giver and that you didn't send her off to some convalescent hospital. It must be a lot of work. But also, I want to say that if your wife had written an advance directive or had told you what she would have wanted (or could even tell you now) when her MS had progressed to this state, you as her surrogate, would have the legal right to stop the food and fluids. You may wish to talk to your physician or the local hospice representatives about this. Unlike the vicious accusations you may have heard in the news media about the Schiavo case which are irrational, there is no prosecution for murder if you are carrying out the wishes of your wife for unwanted treatment in her current severely disabled and progressive state with no known recovery. The act of feeding food and fluid by others is treatment when the inability to access it by herself is part of her underlying illness. Termination of food and fluid is being carried out legally in hospices throughout the country. ..Maurice.

 

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