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Advance Directives Back in the NewsTerri Schiavo in Florida didn't have a written Advance Directive. Verbal instructions to her husband satisfied him, the treating doctors and the Courts; but not her family, the Governor, Congress or the President.So we have again witnessed the same tug-of-war experienced in 1991 when courts wrestled with end-of-life decisions in the Quinlan (NJ), Saikewicz (MA) and Cruzan (MO) cases. We wrote on this issue in Peacock Tales in 1991, and again in 2001. Perhaps we need to "review the bidding" and try to add some light to the heat of the issue. The "Advance Directive" is a medical consent form which permits a person in advance to authorize the removal or withholding of life-sustaining treatment under special circumstances. The issue has always been who can control end-of-life health decisions. Often patients cannot speak for themselves. Relatives may disagree. Physicians are bound by the Hippocratic Oath to protect and extend life. And yet the mere prolonging of the process of dying by artificial means does not satisfy many, if not most people. In 1992, the Pennsylvania legislature tackled the problem and has provided a statutory solution currently being employed by many of our clients. The law is called the Advance Directive for Healthcare Act and was updated in 2002. It permits one to authorize in writing the withdrawal or withholding of medical care, even though one should later become incompetent, when the medical procedure would serve only to prolong dying. The Directive must be signed before two witnesses. The most important provision of the law makes this instruction applicable only when the patient has a "terminal condition" (incurable, irreversible, advanced state) or is "permanently unconscious" (irreversible coma). Two physicians must certify such condition on the medical record. Physicians are bound to honor your direction, and one who cannot for any reason must turn the patient over to another caregiver. The Advance Directive covers all types of life-sustaining treatment, ventilation, hydration, nutrition, medication, surgery, blood products, etc., which would only prolong dying. The Directive specifically provides for continued treatment to keep one comfortable and avoid pain, however. The statute provides a model, minimal consent form. Many law firms, including Peacock Keller, have added provisions so one may include advanced Alzheimer's or other debilitating mental disease. One can also name an agent to deal with physicians and hospitals to carry out your wishes. An interesting and unusual provision in the statute permits one to cancel the written consent verbally at any time by so instructing your caregiver. This "escape provision" protects your right to change your mind and is illustrative of the importance the law places on your right to control the medical care you receive. One should provide a copy of his or her Advance Directive to the family physician and by Federal law, you will be asked if you have one on admission to any hospital for any care or treatment. So be sure to obtain multiple copies if you elect to have an Advance Directive. Some still call the Advance Directive a "Living Will." However, the document is clearly a medical consent form and does not dispose of property, as in your Last Will and Testament. Since the Pennsylvania law designates it as an "Advance Directive," that would seem the preferable term. An Advance Directive is not just for elderly people. People of all ages may have serious accidents or health problems. At Peacock Keller, we urge clients who are preparing Powers of Attorney or Wills to consider the advantages of an up-to-date Advance Directive. |
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