Many Still Seek One Final Say on Ending Life

NY Times ^ | June 17, 2005 | JOHN SCHWARTZ and JAMES ESTRIN

[neverdem]

Interest in living wills - the documents that let people specify what medical measures they want or do not want at the end of life - has surged in the aftermath of the fierce nationwide battle over the fate of Terri Schiavo, lawyers and other experts on all sides of the issue say.

While interest peaked around the time of Ms. Schiavo's death on March 31, it is still strong, these experts say.

Many people are filling out the forms for the first time. Others are taking a new look at forms they filled out some time ago. Most living wills describe the conditions for withdrawing life support, but others demand the fullest extent of treatment.

The results of Ms. Schiavo's autopsy, released on Wednesday, underscored the need to make one's wishes known, said Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. He noted that politicians had been eager to intervene in her case even though it was now evident that her brain was irredeemably damaged.

"The movement to say, 'You've got to have Tom DeLay act as a third-party surrogate witness before you can have medical treatment stopped' seemed to be irrefutably silenced by the autopsy report," Dr. Caplan said.

Since March, Aging With Dignity, a nonprofit group in Florida devoted to supporting end-of-life wishes, has received requests for more than 800,000 copies of its do-it-yourself form, known as Five Wishes, which blends the statement of wishes and the appointment of a medical proxy, a relative or friend with the power to make life-or-death decisions.

That is a 60 times the normal number of requests, said the group's president, Paul Malley. "Mail is coming to us by the truckloads," he said.

[plain talk]

The movement to say, 'You've got to have Tom DeLay act as a third-party surrogate witness before you can have medical treatment stopped' seemed to be irrefutably silenced by the autopsy report," Dr. Caplan said

fairly callous and clumsy statement for a doctor to make.

[legendofamind]

I've said it before and I will say it again because it is true. Your "Living Will" (really Advance Directive) won't save you. I will make legal mincemeat out of anything like that in court as long as I can pile up enough unchallenged hearsay evidence and have the ear of a sympathetic (and probably conflicted) jurist. That is the real and dangerous precedent that the Schivao travesty of justice set, and is conveniently ignored by the "Kill Terri" crowd (because in this case they got their wish for Terri to be killed).

[neverdem]

I've said it before and I will say it again because it is true. Your "Living Will" (really Advance Directive) won't save you. I will make legal mincemeat out of anything like that in court as long as I can pile up enough unchallenged hearsay evidence and have the ear of a sympathetic (and probably conflicted) jurist. That is the real and dangerous precedent that the Schivao travesty of justice set, and is conveniently ignored by the "Kill Terri" crowd (because in this case they got their wish for Terri to be killed).

Does having the durable power of attorney for health care mean that you have to retain a lawyer that you trust? 8^)

[flixxx]

Correct, the Living Will or Advanced Directive provides insight into the patient's prior wishes (assuming he/she cannot make decisions about his/her care). The Next of Kin has the responsibility to carry out the wishes stipulated in the Living Will or what the patient's wishes 'would be'.
So, I guess one must chose his/her spouse very well or designate someone to make those decisions.

[madprof98]

The elites wanted Terri Schiavo dead because her execution was a victory for the medical killing ("bioethics") movement. I expect the Times to continue this crusade with the same fervor they showed when they demanded that private golf clubs admit women.

[legendofamind]

I think it means that your fate is no longer in your own hands, at least as far as earthly powers go. Admission of hearsay evidence and allowing it to be decisive in a case of life and death sets a legal precedent that puts everyone in danger.

But, more fundamentally, I am old enough to remember a time in this country when you didn't need a piece of paper to stay alive. The right of a person to live the life they were granted by a power beyond the ken of mortal man, even if it meant living that life under difficult circumstances, was an unalienable right. That Schiavo case has eroded this concept, perhaps irreparably.

[thoughtomator]

Winners:
Lawyers
Eugenecists
Euthenasia advocates
Abortionists

Losers:
You
Me

[fatnotlazy]

Where I live, there is no law that says you have to choose a spouse or family member as your designee.

[fatnotlazy]

Where I live, there is no law that says you have to choose a spouse or family member as your designee.

[fatnotlazy]

Sorry for the repeat. :(

[Beelzebubba]

Ping re post 4

[flixxx]

I agree, in Nebraska you do not designate your spouse or next of kin as designee...it automatically happens legally. I am sorry if that was not clear.

[fatnotlazy]

That's a bummer.

In my neck of the woods, you can designate who you want. I have no spouse or children...have a brother...but I designated my best friend instead. Not that I don't trust my brother, but he's never home...keep thinking if I needed him to make a decision, he wouldn't be there. My friend is more available.

[flixxx]

Oh, you can designate someone else other than next of kin.

[TASMANIANRED]

A living will is a sure way to guarantee that you will get substandard medical care.

You are indemnifying the hospital/doctor against neglect.

[flixxx]

"A living will is a sure way to guarantee that you will get substandard medical care.

You are indemnifying the hospital/doctor against neglect."



That is probably one of the most ill-informed comments that I have seen on this Board (and there have been many that the Schiavo case has elicited).

A living will provides your family with some direction at a time when it can be very difficult to make decisions. More importantly, one should TALK and DISCUSS his/her wishes with family so that there are no disagrements. Again, the responsibility is to fulfull the wishes of the patient.


A quote from an editorial by Dr. Quill:


In considering such profound decisions, the central issue is not what family members would want for themselves or what they want for their incapacitated loved one, but rather what the patient would want for himself or herself. The New Jersey Supreme Court that decided the case of Karen Ann Quinlan got the question of substituted judgment right: If the patient could wake up for 15 minutes and understand his or her condition fully, and then had to return to it, what would he or she tell you to do?

NEJM April 21, 2005 issue Volume 352:1630-1633

[TASMANIANRED]

I have real life experience , 20 years working in a hospital.

If you are a No Code, you get less attention, you go to the bottom of the list of squeaky wheels.

If you are having change in condition that suggests that something is about to go wrong, it is more likely that it will be ignored than if you do not have that No Code Status.

It may not be right, but it is the truth.

Sorry Charlie, I don't care how ill informed you think my view is.

It is a view formed in real life situations, and not in a judiciary chamber, a legislative body or in an advocacy group office.

[flixxx]

No code does not mean 'no care'...the issue is the goal of the care being delivered.

Comfort care alone vs. going all out full court press with pressors, intubation, chest compressions, etc. Where problems arise is when there is a diffence in goals of care for a loved one between family and physicians...in which case communication needs to be improved...this does not mean that one should not have a 'living will'.

Also, Living Will does NOT equal No Code...they are two very different documents and are often confused.

If I have a living will and God forbid suffer a MI, I WANT to be treated...It is only if I suffer severe anoxic/hypoxic brain injury that I want my wife to step in and stop unhelpful medical interventions. As you know we can keep patients alive years and years with no hope for neurologic recovery...I do NOT want that done to me and I would think (and this is supported by various surveys) that most people do not want that done to them and want the choice to stop medical interventions.

I apologize, I did not mean to question your experience by my 'ill informed' comment, but this issue has been horribly misrepresented by the Press, Congress, Talking Heads, and many on this and other Boards.

[little jeremiah]

later read/ping

[TASMANIANRED]

flixxx, I am sorry that I came back at you like that.

I understand the good intentions of Living Wills and Advanced Directives.

I was a big supporter of them myself about 15 years ago.

I was one of about 15 other people that testified before my state legislature in 2000 about the unintended consequences of
this act.

1)In most states if you are over 65 there is a formula for determining judgements in cases of medical malpractice for death.

It is usually a combination of factors but earning capacity is a huge chunk of it. What would you earn if you lived out the rest of your natural life.

At 65 and over, it is nothing. It doesn't matter what your life means to your family. Only what you can earn.

2)If a hospital does something less than lethal you can sue for pain and suffering, but if they kill you or let you die they come out far better.

Scenario's where I have seen this happen.

79 year old man , previously in good health, had an MI. Came out of ICU in modestly compromised , but improving condition.
Heart rate went to 160, MD was not called. He went itno pulmonary edema and died. Hospital liability 0.
Could have been converted out of SVT with a dose of Cardizem.

2) 69 year old patient 2nd post op for Prostate surgery. Doing well, no malignancy. C/o of being Short of Breath, staff put some oxygen on him.And went no further. Next check he was dead from a pulmonary embolism. Hospital liability 0.

3)Lady 72 comes in with Pneumonia, started on antibiotics, started chilling ,temp went to 104. Tylenol was given but the physician was not called. She was septic, went into septic shock, got moved to ICU in the morning but shock was so advanced that all interventions failed. Hospital liability 0.

4) 69 year old lady, in an MVA. Had a fractured femur. Was admitted and scheduled for surgery the next morning. Checked at midnight, B/p was trending down and heart rate was trending up. Physician was not called. Dead at the 4 am check. Autopsy revealed a lacerated liver. Hospital liability 0.

It is like racial bias. It's not overt, It's not blatant and out there. Staff, especially younger staff has the attitude that if you are a no code that you are comfortable with the idea of your own death.

Because of over work, because of attitude, because of ageism, hospital staff is more likely to over look subtle signs of impending crisis.

I spent 10 years working in ICU, I had a young wippersnapper nurse actually state "What are they doing in my ICU, they are a no code". I snatched her into a conference room and bawled her out.

No Code is supposed to mean no heroic measures. Increasingly it is being used to mean No Concern.

I know your heart is in the right place.

If you have a terminal illness, an Advanced Directive might be in your best interest.

If you are in good health but just getting older and there are things that you do or don't want, you are far , far better off having a very frank discussion with someone not in your immediate family and with no financial interest and preferably with extensive medical knowledge.

Sign a durable power of attorny for medical decisions only.

There are many things that can happen that are not lethal, and something like a ventilator can be a temporary bridge to recovery.

[TASMANIANRED]

Judging by the way you write, I am assuming that we are about the same age.

We came up in a generation that had respect for life.

I am not being very adroit in explaining there is a huge difference between the care you get from a older nurse than you get from a younger one.

Younger nurses are very skilled and knowledgeable about the science and art of nursing. There is something lacking in many of them as humans.

A nurse 25 year old, has never lived in a world where abortion was not available on demand. They have only lived in a world where the enlightened Europeans were practicing euthanasia. Since schools of nursing are in "liberal" institutions even in nursing they are indoctrinated.

I know the difference between a Living Will, A No Code, What an advanced directive is.

The average age of a nurse is 50. Increasingly , the old fossils like me are leaving nursing and the youngsters are taking over.

I am fearful now of the quality of care in hospitals. I am dreadfully afraid of what it is going to be like in 20 years when I am in the group of retired.

My best advice. Get your living will and keep it secret from the hospital. Give it to your spouse, your lawyer, your neighbor, but not the hospital.

If the time comes where it is actually called for, then bring it out.

[little jeremiah]

Thank you for your insights and tales of experience.

[little jeremiah]

Moral Absolutes Ping.

Good discussion on Living Wills, Advance Directives, what they really mean, and what happens in real life/death. Make sure you read TASMANIANRED's comments.

Freemail me if you want on/off this pinglist.

[Checkers]

"Winners:
Lawyers
Eugenecists
Euthenasia advocates
Abortionists

Losers:
You
Me"


The Death Cult would call that "win-win."

[TAdams8591]

It's an OPUTRAGEOUS statememnt for him to make. I think I will give him a call.

[MHGinTN]

"The movement to say, 'You've got to have Tom DeLay act as a third-party surrogate witness before you can have medical treatment stopped' seemed to be irrefutably silenced by the autopsy report," Dr. Caplan said. Gee, no bias in this death cultist/democrap party sycophant's rhetoric!

[TASMANIANRED]

Thanks for your kind remarks.

I used to be a big supporter of living wills when they first started being discussed.

It seemed right and proper that people should have a say so in what happens to them at the end of their lives.

Then the Law of Unintended Consequences kicked in.

If you have a terminal illness they still may be a good thing.

However there are many many things that can happen that are temporary set backs and are completely correctable.

It is far more likely that you would experience a post OP Mi, a cardiac irregularity, a minor pulmonary embolis, a DVT, pulmonary edema, than it is to have a lethal occurrence.

There is no reason for a fatality for a non-lethal situation.

A Living Will/No code status greatly increases your chance of death from correctable situation.