RICHARD NIXON: 1913-1994 : Groups Report a Surge of Interest in ‘Living Wills’

The late Richard Nixon’s decision to make his explicit wishes known about the course of his medical treatment during his final hours has resulted in a surge of new interest in the concept of the “living will,” medical ethicists and others said Monday.

“Our lines have been completely jammed,” said Ann Fade, director of legal services for Choice in Dying, a New York-based organization that provides forms for people interested in writing such documents. “We send out about a quarter of a million living wills a year--but the number goes up, depending on what’s happening in the news.”

She said her organization, which sends the paperwork for free, typically receives 100 to 200 telephone calls a day, but in the days since Nixon’s death, “we’ve been getting 500 a day.”

The former president, who died Friday night in New York four days after suffering a major stroke, apparently had made it clear that he wanted no extraordinary medical measures taken if he developed a serious condition that would leave him incapacitated, particularly intellectually.

Despite the advantages of living wills, studies show that no more than 20% of the U.S. population has them, experts said.

“It’s hard to get people to do it,” said George Annas, director of the law, medicine and ethics program at Boston University. “Hardly any Americans fill out any forms at all unless they’re required by law. They don’t want to think about death. Or when they think about it, they would rather talk about it than write something down. They’re superstitious. My mother’s like that--’If I write it down, it means I’m going to die.’ ”

Fade, of Choice in Dying, said “most people think: ‘Oh, I want my family to make these decisions for me,’ ” and automatically assume they can, when “in some states, your family can’t--treatment just has to continue. The family doesn’t always have a say unless you specifically designate them.”

Most experts believe that while a living will is useful, it may be more valuable to give a surrogate a “health proxy”--granting that person the legal status to make critical medical decisions in the event an individual is incapable of doing so. Living wills by themselves may prove to be inadequate because they cannot address all potential medical situations and are subject to interpretation.

Most states have statutes providing for the right of individuals to create living wills, also known as advanced directives, and to appoint health proxies who have the durable power of attorney.

In 1976, California became one of the first states in the nation to establish statutes providing for living wills and health proxies.

The statutes make it clear that medical personnel following instructions in a living will are not criminally liable, said Alex Capron, UCS professor of law and medicine.

It is important to talk with the surrogate at length “and make your wishes known,” Capron said.

Also, all states are subject to the Patient Self-Determination Act, a federal law that requires all health care facilities--hospitals, nursing homes, hospices--to offer patients information about the relevant laws in their state regarding living wills and durable power of attorney.