Terri Schiavo: Living wills can't cover all possibilities 
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 Terri Schiavo: Living wills can't cover all possibilities

Terri Schiavo: Living wills can't cover all possibilities

By Sharon Emery
Ann Arbor News
Wednesday, March 23, 2005

Lansing - The living will, held out as the blessed escape
hatch for avoiding the kind of battle being fought over
Terri Schiavo, is the last place you should be looking
for refuge, University of Michigan researchers say.

Unless you're close to death and know what medical
choices you'll be facing, anticipating some hypothetical
future is almost impossible, said Angela Fagerlin,
research scientist with the University of Michigan
Medical School and Veterans Affairs Ann Arbor Healthcare

"People have a really difficult time predicting their
preferences," Fagerlin said. "And 30 percent of
preferences change in as little as a year. Even when we
know better, we tend to mispredict how we would act in a
certain situation."

Fagerlin wrote "Enough - The Failure of the Living Will"
with U-M law school and medical school professor Carl E.
Schneider, published last year in the bioethics journal
The Hastings Center Report.

What they found after reviewing hundreds of studies of
living wills, end-of-life decisions and the psychology of
making choices is that living wills offer a false promise
of control over end-of-life treatment.

"There's no empirical evidence that they work," Fagerlin
said. "...(they) might make people feel more confident
that their wishes will be honored, they may make
surrogates (decision-makers) more confident, but there's
little correlation between having a living will and
getting what you want."

A better choice is a durable power of attorney, she said,
which names who will make decisions when the patient
becomes incapacitated. While Michigan residents can
outline their wishes in living wills to guide their
doctors and families, a durable power of attorney is the
legally binding document for end-of-life care.

Yet even with the durable power of attorney, the patient
is depending on the surrogate to do the right thing under
often unforeseeable circumstances.

"What matters most is that loved ones feel good about
their decision," Fagerlin said. "Some (dying) people are
happy for families to override living wills if they think
they're acting in their best interest."

That's a good thing, since studies show that surrogates
are no better able to predict what someone would want if
they have a living will to refer to than if they don't,
she said.

In Michigan the Supreme Court has set the bar a little
higher for specifying what you want, said Dr. Howard
Brody of the Center for Ethics and Humanities in the Life
Sciences at Michigan State University.

Brody said that in the so-called Martin ruling, the court
ruled against honoring the patient's apparent wishes
because he hadn't indicated that he would refuse
treatment in his specific medical condition.

"To the extent that you have wishes in particular
situations, be sure you try as best you can to get
medical language in here," Brody said. "Because of that
ruling, you need to be specific."

He advises asking your doctor for help with the wording.

The most common cause of battles over treatment is that
the family has never discussed the issue, even when the
patient has a living will or durable power of attorney,
Brody said.

"Usually with extra time and conversation, everything
works out all right, but it takes time," he said. In the
meantime, a patient's wishes may be delayed.

In a case where a patient's ventilator is turned off on
Friday instead of the previous Monday due to family
disagreements, "that means there were four days when the
patient's wishes were not honored," Brody said.

Fagerlin fears that the Schiavo case could ultimately
curtail the role of surrogates in terminating care.

"We really need to emphasize that there is a right to
refuse treatment," Fagerlin said. "It would be a terrible
outcome of this case if we don't let surrogate decision-
makers make decisions to remove treatment."

Contact Sharon Emery at (517) 487-8888, ext. 236, or


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How true this is.

Posted on 3/25/2005 10:48:03 AM PST by msuMD

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 -To: msuMD

When people write their advance directives for health
care--they need to consider the impact of what looks like
a simple decision. I advise that the directives include a
team of people to help make the decision. This may
include, the spouse, the family minister and the
attending physician. In this way, the person ultimately
responsible for the final decision can make that decision
with support. That way they won't feel guilt for having
made the decision.

Posted on 3/25/2005 10:56:48 AM PST by truthingod

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 -To: msuMD

In our state it helps if you have three documents:

Living Will,

Health Care Surrogate, or Durable Healthcare Power of

and then the regular Durable Power of Attorney (which
allows you to conduct business, but not make health care

Everyone in our family has all three. When my MIL and FIL
were dieing we referred to their Living Wills, but the
decisions were left to my husband because he was their
Health Care Surrogate.

The Living Will did nothing for us legally, it just let
us know what their end of life wishes were.

The Durable Health Care Surrogate was the legal means to
see that their wishes were carried out.

Posted on 3/25/2005 10:57:22 AM PST by dawn53

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 -To: msuMD

Of what use is a "living will"? All your spouse needs do
do is convince a Florida judge that you wanted to die by
starvation, and their goes your "living will".

Posted on 3/25/2005 11:02:58 AM PST by MisterRepublican
   (End Judicial Tyranny Now!)

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 -To: msuMD

What you need is an advance directive - they are very
specific. This, I think is the best one - it is from the
National Right to Life and so is written to be biased
towards life.


Of course, Terri's great error was she chose as a husband
a person with deficient m{*filter*}values. The most important
thing we can do is designate a person who has our own

Posted on 3/25/2005 11:07:57 AM PST by I still care
   (America is not the problem - it is the solution..)

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 End of forwarded messages

Jai Maharaj
Om Shanti

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The terrorist mission of Jesus stated in the Christian bible:

     "Think not that I am come to send peace on earth: I came not so send
peace, but a sword.
     "For I am come to set a man at variance against his father, and the
daughter against her mother, and the daughter in law against her mother in
     "And a man's foes shall be they of his own household.
 - Matthew 10:34-36.

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Wed, 12 Sep 2007 03:10:16 GMT
 [ 1 post ] 

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