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Schiavo case shows need for medical care instructions, experts say

WASHINGTON—Legal experts hope the Terri Schiavo case spurs more families to develop written legal instructions on the type of medical care a loved one should receive if that person is unable to decide for herself.

Known as "advance health-care directives," these documents usually come in two forms: a "living will" or a "health-care proxy," also known as a "health-care surrogate" or "durable medical power of attorney."

A living will informs family members and care providers about the kind of medical care a person wants or doesn't want in the event he becomes terminally ill, permanently unconscious or in a persistent vegetative state without discernible brain activity.

A health-care proxy also can express a person's desire for care in certain conditions, but its main purpose is to grant medical decision-making power to a third party, usually a close friend or relative, when the patient is medically unable to make such decisions.

For that reason, legal experts say, a health-care proxy is preferable to a living will for ensuring that a person's medical wishes will be fulfilled.

State requirements for living wills and health-care surrogates vary, said Dennis Belcher, an estate lawyer in Richmond, Va. Most states require the documents to be witnessed by more than one person. A few require them to be notarized, Belcher said. Both documents can be updated and amended.

Most hospitals require patients to sign a power of attorney before being admitted or treated, but the documents apply only while the person is in that facility's care.

While there's no easy way to discuss preparations for terminal illness or life-threatening injuries, the Schiavo case shows that the best time is always before such tragedies occur.

"People should learn from the family conflict that this case has engendered that they should develop written documents that make certain that their wishes about how they want health-care decisions to be made for them will be taken into account," said Nancy Coleman, the Washington-based director of the American Bar Association's commission on law and aging.

Living wills typically reflect a person's desires regarding life-sustaining care, such as connection to ventilators or to intravenous feeding that artificially sustains life, Coleman said. Only adults can take out living wills and, with only a few exceptions, the same is true for health-care surrogates, Coleman said.

Belcher said one of the best times to name a health-care proxy was when making marriage preparations. Doing so will avoid the possibility of in-laws fighting over what medical decisions to make. "That's what the Schiavo case is all about," he said. People undergoing medical treatment also should consider health-care proxies, as should people doing estate planning, Belcher said.

Forms for living wills and health-care proxies can be obtained from many places, but experts suggest contacting a lawyer in your state. Fees are usually less than $100, but can increase depending on the document's complexity. For instance, a person who wants her medical decisions made by a majority vote of her three children would pay more for a proxy than if she simply authorized one child to make decisions, Belcher said.

For more information about living wills and health-care surrogates, see the American Bar Association Web site at www.abanet.org/rppt/public/living-wills.html#livingwills.

For a list of publications and organizations that assist in health-care planning go to the ABA Web site at www.abanet.org/elderly/toolkit/tool10-lock.pdf.

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(c) 2005, Knight Ridder/Tribune Information Services.

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