http://www.sacbee.com/content/lifestyle/story/12605440p-13459740c.html
http://www.sacbee.com/content/lifestyle/story/12605440p-13459740c.html
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Lifestyle
Honoring your wishes: Put them in a living will
By David Barton -- Bee Staff Writer
Published 2:15 am PST Tuesday, March 22, 2005
As the court case and life of Terri Schiavo hang in the balance, a host of questions mount, to which there seem few black-and-white answers. The legal, ethical, spiritual and political debates have been heard in Florida courts at least 15 times. Some were heard again Monday by a federal judge as Schiavo entered her third day off the feeding tube that has kept her alive for 15 years.
Only 12 percent to 13 percent of people age 50 and over have their wishes legally recorded in a living will, in which an individual is able to state what sort of life support he or she wants to be given. Anyone over the age of 18 can have a living will drawn up, and it must be witnessed by two adults or notarized.
Caplan, a national expert on ethics and end-of-life issues, said the Schiavo case, though it has drawn international attention, is not essentially different from the "thousands" of cases every year in which family members do legal battle over what to do with a family member who can't make his or her own choices.
But this case has become different, says Caplan, whom we caught on his cell phone as he walked across the Philadelphia campus to give a speech to the Parents Council at Penn on Monday afternoon.
Q: Is this case common, or unique?
A: There are thousands of these cases a year. There's nothing unique about families fighting over this. There's nothing unique about removing a feeding tube from someone who is unconscious. What's unique is having a family fight draw the attention of the pope and the president of the United States.
Q: Why do you think it has done so?
A: Because the president has what he sees as a mandate to enforce moral values, as he sees them. And he has a Congress that will go along with him. Until now, Congress has left these matters to state courts.
Q: But isn't a consensus building about end-of-life issues, and isn't this part of the process?
A: The consensus isn't building - it's been built over the last 30 years, case by case, state by state. From state to state, people know that you can stop treatments, that you should respect the wishes of competent people, that you should respect the wishes of the next of kin. And this Congress could blow all that up overnight.
Q: How so?
A: They're opening the door to where all of these matters are going to end up in federal court. I think they're opening an enormous can of worms. Besides that, turning it into an issue of life and death is missing the point.
Q: It is? So, what is the point?
A: The question is how to honor someone's wishes when they are incapacitated; that's where the law has focused for 30 years. And in most of those cases, the courts have found that the spouse has the traditional responsibility. It's been true in many court decisions, including many end-of-life decisions. It's been true in the prior decisions on this case, all 15 of which came down in favor of the spouse, Michael Schiavo.
Q: Religious belief plays a role in this, doesn't it?
A: Yes. People say, "I'm a Catholic and I can't remove a feeding tube," or an Orthodox Jew might believe that someone's not dead until their heart stops, whatever the functioning of their brain. And they are entitled, under current law, to make decisions based on those beliefs.
But the irony here is that the president and Congress, acting on their religious beliefs, are actually stepping on the beliefs of some of their core constituents.
Again, the issue is respect for people's choices. When a Jehovah's Witness or a Christian Scientist says, "I don't want medical care," we honor their convictions, even if they might die because of them. It's about what each individual wants. And this might undermine that.
Q: How would it undermine that right?
A: Well, if you wind up saying that you must treat if there's any doubt about what the patient wanted, you're setting the bar very, very high for religious people. People who are fundamentalist Christians, Hmong people who don't use Western medicine, people who believe in natural healing - they're going to have to be treated unless they carry around a written statement, which some of them refuse to do, because they assume that their families will take care of it for them. In some families, it's assumed that the senior male will make the decision; a woman would not presume to make that decision for herself.
Q: Are we at a point where a "natural" death is going to be quite rare?
A: Yes, we're already there. Very few people die at home, without some medical technology. Anyone who dies in a nursing home or hospital has at least one instance of a decision made not to resuscitate. Because of the treatments and technologies we have now, we always have to decide, at some point, not to use some of them.
Q: Does a living will actually help to avoid this?
A: Oh yes, definitely. It's not something people under the age of 50 or even older think about. So, if you're over 18, you should make your wishes known. And fill it out with other people, so the people who will survive you know about it. Don't just stick it in a folder. It'll save a lot of people a lot of difficulty. And be sure to update it every couple of years.
Q: Why? Does it expire?
A: No, a 12-year-old living will has as much legal force as a newer one, but psychologically, it helps the survivors. It helps them understand that you felt the same way more recently, that you knew what you wanted. And that makes the whole thing easier.