Advance Directives
In 1983, 25-year-old Nancy Cruzan, as a result of an auto accident, awoke from a
coma in a persistent vegetative state. After four years awaiting a recovery,
Cruzan's family sought to remove her feeding tube. After three years of court wrangling,
the Cruzan family finally convinced a judge that Nancy would not have wanted to
live on artificial life support and received permission to have Nancy's feeding
tube removed.
In 1990, 26-year-old Terri Schiavo collapsed in her home. After ten weeks in a coma,
Schiavo awoke in a persistent vegetative state. In 1998, Schiavo's husband sought
to remove her feeding tube. What ensued was a seven-year court struggle pitting
Schiavo's husband against her parents in a battle over whether to continue artificial
life support. One of the common themes of these two women was that neither Cruzan
nor Schiavo had advance directives expressing their wishes regarding artificial
life support or other life-sustaining medical care. Both cases involved families
going to court and asking judges to interpret what the incapacitated person's wishes
were. In the Schiavo case, that court battle featured an extremely bitter struggle
between Terri's husband and her parents.
An advance directive notifies your caregivers what kind of treatment you would like
to have if you lose the ability to make medical decisions (for instance, if you
become comatose or were in a persistent vegetative state). Many hospitals discuss
advance directives with their patients at the time of the patient's admission.
There are two common types of advance directives. The durable power of attorney
for health care allows you to name an attorney-in-fact for health care decisions
(also called a "proxy" or "advocate") who will make decisions on your behalf regarding
what treatment you do, or do not, want.
The other advance directive, the living will, contains a set of instructions to
health care providers to be followed in the event that you cannot communicate your
wishes for yourself. A living will usually sets out specific directions as to the
course of treatment that your caregivers should take, or, perhaps most importantly,
sets out the treatments you wish to forbid your caregivers to undertake. These instructions
are to be followed if you are unable to give informed consent due to incapacity.
A living will is an important tool for both your peace of mind and that of your
family. With a living will, both your family and your doctors know what your wishes
are. It can save you from subsisting in a state that you would never want to be
in, and it can save your loved ones the painful burden of making end-of-life decisions
on your behalf.
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