Planning ahead will assure your wishes are observed and save your loved ones emotional turmoil
By: Jane Berger
In 1990, seemingly vibrant at the age of 26, Terri Schiavo probably never dreamed her heart was about to stop, leaving her in a vegetative state and her family embroiled in a legal battle over her future medical care. Had she been able to speak for herself, Schiavo’s husband and parents would have been spared the frustration, anxiety and guilt of having to fight for what they each believed would have been her wish.
While Schiavo’s highly publicized case traveled all the way to the Supreme Court before her feeding tube was ultimately removed, the decision to forego life support efforts was a relatively private matter for Pope John Paul II. In contrast to Terri Schiavo’s situation, the pontiff remained alert enough through his illness to make his own decisions about medical care, choosing to forego many aggressive measures, including life support.
Unfortunately, there is no crystal ball to tell us which, if any, of these scenarios we may face in our lives. But there is a relatively simple way to guarantee that your wishes be respected regarding medical care if you are ever unable to make those desires known. Planning ahead will assure your wishes are observed and save your loved ones the emotional turmoil of having to make a life decision for you should you be in a coma, on life support or have a terminal or irreversible illness.
Many times, as in the Schiavo case, family members disagree on how to handle the situation, which can result in breaches in family relations. To protect your rights and interests, and to eliminate the need for family members to play a guessing game about your wishes, certain legal documents should be drafted in advance of any illness.
"In general terms, these documents are referred to as advance directives, and are written instructions prepared while someone is healthy, outlining the actions to be taken if the person becomes mentally or physically unable to make decisions for him or herself," explains Jane Berger, manager, Patient Relations at University Medical Center at Princeton.
"There are three main types of advance directives: living wills, durable power of attorney for health care and combined directives.
"Living wills let you specify what types of medical treatment you will accept or reject as death-delaying methods when faced with a terminal illness, while a durable power of attorney allows you to name a representative (proxy), such as a family member or close friend, to make health care decisions on your behalf if you lose your decision-making ability.
"Choose someone who knows you and your values well, is familiar with your feelings about different types of medical treatment and the conditions under which you would choose to accept or refuse either a specific treatment or all treatment, and someone who agrees to respect and follow your wishes," advises Ms. Berger.
A combined directive, which is the documentation recommended by the Biomedical Ethics Committee of University Medical Center at Princeton, combines the two legal documents, allowing you to specify your treatment wishes and to name a health care proxy.
You should also consider whether you wish to have cardiopulmonary resuscitation (CPR) or related procedures performed in crisis situations where survival may be unlikely. If there are circumstances in which you would not want to be resuscitated, this can be conveyed through a do-not-resuscitate order, or DNR.
By law, when heart or lung function stops, health care providers such as EMTs, nurses and physicians are required to do everything possible to restore and maintain those functions. This includes the use of CPR, mechanical ventilation (respirator) or other measures. If you have a DNR order specifying your wishes, medical personnel will not attempt to revive you with these measures.
Having a do-not-resuscitate order does not mean that all other medical treatment will be discontinued, Ms. Berger advises.
"When making decisions on when to withhold or withdraw treatment, please be assured that pain management, supportive care and comfort care will always be given at University Medical Center at Princeton," she says. "Additionally, many important variables are taken into consideration before activating an advance directive."
Initially, the physician evaluates the patient’s incapacity and then discusses his or her findings with the person authorized to make medical decisions on the advance directive. In evaluating the patient the physician considers the nature of the injury or disease, the prognosis and chances for rehabilitation, and the risks, benefits and burdens of treatment options and alternatives.
As a competent adult, you have the right to make your own decisions about your health care. These may be dictated by personal ethics, morals and religious convictions. Giving consideration to your personal views about your quality of life, illness, disability, putting responsibility for your care onto your family and the financial burden it may pose can help in the decision-making process.
Do not wait until tragedy strikes to document your wishes. It is difficult to make sound decisions in the midst of an unexpected crisis. It is better to discuss your thoughts and health care wishes with loved ones, clergy members, physicians and other caregivers before you become ill.
For additional information on advance directives, please call the Office of Patient Relations at University Medical Center at Princeton, (609) 497-4477.

