Putting legal clout behind your wishes

Times Staff Writer

Whether you want to be kept alive with all medical technology available -- or for life-support measures to be discontinued if there is no chance of a meaningful recovery -- it's important to specify those wishes in writing.

Such a document will not necessarily resolve everything, but it will go a long way in making it easier to decide how long and under what conditions to keep a person alive. Most U.S. courts and hospital ethics committees will try to honor a patient's written wishes.

In addition, a living will could lessen the guilt a relative might feel, particularly about starting or stopping life-support systems. It also could help prevent costly, lengthy and bitter family feuds when the desires of the patient are known.

A health-care proxy also should be designated to make decisions on one's behalf. Usually a spouse, parent or adult child of the patient is chosen, but sometimes the choices might be too difficult for them -- such as when a patient would want to forgo life support. In most states, the proxy can be anyone over 18 other than a health-care provider. (One man at UCLA designated his landlord.)

It is important to discuss one's choices with the proxy, so he or she knows whatmust be done.

Rather than trying to outline all the possible medical scenarios, suggests Atlanta family-law attorney John Mayoue, the discussion should focus on the quality of life that one is interested in maintaining.

"The overall debate has moved from the sanctity of life to the quality of life, which is a much more pertinent discusion," Mayoue says.

"It's so important now, because you can keep somebody alive in a life form that would not be worth living."

The document must be properly witnessed (most states require the advance directive to be notarized and signed by at least two parties who have not been designated as the patient advocate, health-care provider or an heir of the patient.)

Copies of the document should be discussed with and given to family members and/or close friends, as well as the person's physician and hospital.

The directive should be included with a patient's medical chart. Hospitals are required by law to provide information about advance directives to people in their communities, and to ask each patient upon admission if he or she has one, and if not, if they want one.

Documents, which vary by state, also can be obtained online.

* Partnership for Caring provides specific advance directive forms for each state at www.partnershipforcaring.org.

* Aging With Dignity offers details about getting its "Five Wishes" document ($5 for one, less for multiple copies) at www.agingwithdignity.org). The document, which is valid in 35 states, including California, is much easier for most people to understand than the state documents. It is much more personal, offering in layman's terms the opportunity to specify how comfortable you want to be, how you define life support, even how you want to be treated: Would you like visitors from church? Music in the room? Your bedside surrounded by pictures?

To ensure that medical-care providers anywhere you might be traveling can gain access to the document, Health Directives (www.healthdirectives.org, or [866] MED-WISH), of Washington Crossing, Pa., will scan the documents and give you several wallet-sized cards specifying how medical providers and loved ones can obtain your document from the Web site.

For $15 annually -- mostly paid by hospitals who share in revenues -- the company will make sure the living wills are kept up to date and signed each year -- the older the document, the less likely it is to hold sway in a debate, says Health Directives founder Peter Heisen.

The U.S. Living Will Registry (www.uslivingwillregistry.com) also offers a similar service. Both companies provide links to basic state forms and where to get information, but will accept and scan into their computer whatever documents are provided.

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