The Importance of an Advanced Directive

The case of Terri Schiavo has unfortunately pointed out a very important point that Americans need to be conscious of. Terri Schiavo was the unfortunate pawn in the middle of a battle between her parents and her husband over whether withdrawal of medical aid following an accident which left her totally incapacitated.

The media circus which ensued reached to the highest levels of the government, even taking this matter to the level of the Supreme Court and to the office of the President of the United States. Unfortunately, prior to her accident, Terri left no living will or advanced medical directive to clearly spell out her wishes were she to find herself in such a dire condition.

Lacking any clear directives on her part, the situation degenerated into a she said/he said battle of wills between what her husband reported Terri's wishes to be, and what her parents believed those wishes to be. In the end, her husband's opinion won out, life support was withdrawn, and in matter of days Terri was gone.

No matter on which side you fall in this issue, this case glaringly served to point out how important it is to have a living will, or advanced medical directive in place. Like most Americans, Terri was apparently too uncomfortable to discuss the issue with her friends, family and parents in a manner which was clear to all parties involved. Statistics show that too few Americans are willing to face the necessity of preparing either a regular will or an advanced medical directive.

Experts speculate that Americans seem to believe that to prepare these documents somehow brings them closer to death, and by ignoring them they can put off the inevitable. In actuality, these documents should be prepared as early in a person's life as possible. Like regular wills, these documents should be periodically reviewed and updated to reflect life changes (like a marriage, divorce, birth of children, etc.).

For those unfamiliar with it, a living will, also known as an advanced medical directive (they can have different titles in different states)., is a document which contains your written directions on how you want to be treated under certain medical conditions, or your wishes concerning medical treatments at the end of life. It is often accompanied by a specific type of power of attorney or health care proxy (allowing another person or "proxy" to act in the individual's stead should they be too incapacitated to do so for themselves).

These are legal instruments that are usually witnessed or notarized. Depending on your state's law, this document may permit you to express whether or not you wish to be given life-sustaining treatments in the event you are terminally ill or injured, to decide in advance whether you wish to be provided food and water via intravenous devices ("tube feeding"), and to give other medical directions that impact the end of your life.

"Life-sustaining treatment" means the use of available medical machinery and techniques, such as defribrilators, heart-lung machines, ventilators, and other medical equipment/techniques that will sustain (and possibly extend your life), but which will not by and of themselves cure your condition. In addition to terminal illness or injury situations, most states permit you to express your preferences as to treatment using life-sustaining equipment and/or tube feeding for medical conditions that leave you permanently unconscious and without any detectable brain activity.

They can also contain such options as whether or not which, if any, you wish of your organs to be donated (in addition to or in place of an organ donor card).

The laws in most states require that before your living will can affect medical decision-making, two physicians must certify:
- You are unable to make medical decisions
- You are in the medical condition specified in the state's living will law (such as "terminal illness" or "permanent unconsciousness"),

Other requirements also may apply, depending upon the laws of the state but this gives you a start on how to set up your own directive to eliminate problems in the future.