Reprinted from the Health District's quarterly publication mailed to district residents - Summer 2005

Terri Schiavo’s legacy is that fewer people will share her fate.

The recent death of the brain-damaged Florida woman whose life was sustained for 15 years by a feeding tube has raised the delicate issue of advance directives for end-of-life medical care.

Only 26 when she suffered brain damage as the result of heart failure, Schiavo did not leave anything in writing about what she would want if she ever became incapacitated. After lengthy court battles, her feeding tube was removed March 18, and she died 13 days later. Since the highly publicized battle over Schiavo’s fate, local attorneys have seen an increase in people coming in to draw up advance directives.

Hospice of Larimer County has been flooded with requests for copies of the “Five Wishes” document created by the Aging With Dignity organization to act as both a living will and a medical power of attorney.

“Many people will tell their loved ones that they don’t want to be kept alive by machines, that they want to be let go,” says Bonnie Inscho, a therapist at Connections who has worked as a medical social worker at hospitals and nursing homes for 10 years. “But then a situation arises when these type of decisions have to be made and if it’s not in writing, it’s very difficult for the family.”

Nationally 10 percent to 30 percent of people have one or more of the following types of advance directives:

• Medical Power of Attorney which designates someone to make medical decisions for you in the event you are unable;

• Living Will, a document stating which life-sustaining measures, such as mechanical respiration and tube feeding, you do and don’t want in the event you become terminally ill; and

• Do Not Resuscitate (DNR) Order, which instructs medical personnel not to perform CPR to get your heart and/or lungs working again. 

“I think people intend to have these documents drawn up but, in the press of daily life, they don’t get to it,” says Shannon McClanahan, a licensed clinical social worker at Poudre Valley Hospital. “People are generally optimistic. They think it’s a good idea to have them (advance directives), but they don’t think they need them now.”

Federal law requires that upon admission to the hospital, patients be asked if they have advance directives. If patients don’t, they are given the opportunity to create them at no charge.

Having the documents done in advance of ever entering a hospital is recommended. For it may be too late for your wishes to be made known if you go into the hospital after an accident or other trauma that leaves you incapacitated (as was the case with Schiavo) or if you have dementia.

“The more decisions you make in advance, the better,” says Linda Brown, admissions team manager for Hospice of Larimer County. “We’ve found that people who have their affairs in order are more calm and have more energy to address the many other issues they are facing.”

Advance directives aren’t just for the terminally ill.

“Many people assume that if something happens to them, their spouse would automatically be the decision-maker for them,” McClanahan says. “In Colorado, that’s not the case. We don’t have a priority list, so you have to designate who that person will be.”

That’s where a medical durable power of attorney comes in. It’s a document you sign naming someone (called your agent) to make your healthcare decisions for you in the event you are unable.

“The trend we’ve seen is toward people only having a medical power of attorney,” McClanahan says, noting that this option provides more flexibility.

Say, for example, you have a close family member or friend whom you trust and who knows your wishes, that person as your agent could make decisions in concert with your physicians at the time you become incapacitated about your day-to-day care as well as treatment options.

Fort Collins attorney Tom Selken offers both a medical power of attorney and a living will to clients who come in for estate planning. Advance directive forms are also available through Poudre Valley Hospital and Hospice of Larimer County and  need not be drafted by an attorney.

When drafting living wills, Selken uses the format laid out by state statute. In Colorado, your living will does not go into effect until two doctors agree in writing that you have a terminal condition. Your living will can state if you want artificial nourishment removed after a one-week waiting period required by law, after an amount of time specified by you or if you want to remain on a feeding tube indefinitely.

If you have both a living will and a medical power of attorney, the living will takes precedence because it spells out your wishes, Selken says.

However, because living wills tend to be limited in what they can accomplish and what conditions they cover, many experts recommend having a medical power of attorney. Living wills often need interpretation, and an agent (medical power of attorney) can provide that. But if there is no one close to you whom you would trust with making medical decisions for you, a living will is your only option.

Of course, while having your wishes in writing is a good idea, it’s no replacement for conversation with loved ones about this important topic.

“Having legal documents doesn’t mean you shouldn’t talk to your family members about your wishes,” Inscho says.

“Having your family clear on what you want takes the burden off of them.”