Preparing for the Final Exit : A little discomfort now can save a family anguish later

A current bestseller, “Final Exit,” outlines for a terminally ill patient how to commit suicide. The controversy and impassioned discussion about the book demonstrates how deeply the issue of death affects Americans at a time when there is more and more technology available to prolong life.

Before Mary O’Connor of New York suffered a series of debilitating strokes in 1985, she told her family she was opposed to being kept alive by artificial means in the event she was unable to care for herself. Three years later when O’Connor was hospitalized and hooked up to a feeding tube, her family tried to fulfill her wishes. But a court said no. Consequently, O’Connor was subjected to prolonged suffering and her family made to endure unnecessary emotional and economic distress.

The outcome might have been far different had O’Connor taken the time to put her verbal wishes in writing.

The O’Connor case is not unique. Just last year 33-year-old Nancy Cruzan, in what doctors call a “persistent vegetative state” since a serious car accident in 1983, was finally allowed to die after her family fought for four years to stop artificial feedings. Although opinion polls show that between 75% to 90% of the U.S. population would not want to be kept alive on life support when the treatment is not going to do any good, only 5% to 10% of American adults use advanced written directives. In California, the Durable Power of Attorney for Health Care allows a patient to appoint an “attorney in fact” specifically authorized to make medical treatment decisions on the patient’s behalf, in the event that person loses the ability to make or communicate such decisions.

Medical technology now sustains life far longer than ever imagined. Ideally, the decision to refuse medical treatment in cases of terminal illness or prolonged incapacitation should be made by the individual, not later on by a judge or a doctor. That has been the painful lesson illustrated by the poignant story of O’Connor and other right-to-die cases.

Beginning this December, a federal law will help ensure that many patients are better informed of their rights. The law requires that all health-care institutions participating in Medicare or Medicaid provide written information to patients that will describe their medical-treatment rights under state law.

Planning out an advanced directive can be an unpleasant and even frightening task. But the temporary discomfort of making the decision is minute compared with the anguish that a family can go through in the absence of such a document.