Many Still Seek One Final Say on Ending Life

Interest in living wills - the documents that let people specify what medical measures they want or do not want at the end of life - has surged in the aftermath of the fierce nationwide battle over the fate of Terri Schiavo, lawyers and other experts on all sides of the issue say.

While interest peaked around the time of Ms. Schiavo's death on March 31, it is still strong, these experts say.

Many people are filling out the forms for the first time. Others are taking a new look at forms they filled out some time ago. Most living wills describe the conditions for withdrawing life support, but others demand the fullest extent of treatment.

The results of Ms. Schiavo's autopsy, released on Wednesday, underscored the need to make one's wishes known, said Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. He noted that politicians had been eager to intervene in her case even though it was now evident that her brain was irredeemably damaged.

"The movement to say, 'You've got to have Tom DeLay act as a third-party surrogate witness before you can have medical treatment stopped' seemed to be irrefutably silenced by the autopsy report," Dr. Caplan said.

Since March, Aging With Dignity, a nonprofit group in Florida devoted to supporting end-of-life wishes, has received requests for more than 800,000 copies of its do-it-yourself form, known as Five Wishes, which blends the statement of wishes and the appointment of a medical proxy, a relative or friend with the power to make life-or-death decisions.

That is a 60 times the normal number of requests, said the group's president, Paul Malley. "Mail is coming to us by the truckloads," he said.

flixxx, I am sorry that I came back at you like that.

I understand the good intentions of Living Wills and Advanced Directives.

I was a big supporter of them myself about 15 years ago.

I was one of about 15 other people that testified before my state legislature in 2000 about the unintended consequences of
this act.

1)In most states if you are over 65 there is a formula for determining judgements in cases of medical malpractice for death.

It is usually a combination of factors but earning capacity is a huge chunk of it. What would you earn if you lived out the rest of your natural life.

At 65 and over, it is nothing. It doesn't matter what your life means to your family. Only what you can earn.

2)If a hospital does something less than lethal you can sue for pain and suffering, but if they kill you or let you die they come out far better.

Scenario's where I have seen this happen.

79 year old man , previously in good health, had an MI. Came out of ICU in modestly compromised , but improving condition.
Heart rate went to 160, MD was not called. He went itno pulmonary edema and died. Hospital liability 0.
Could have been converted out of SVT with a dose of Cardizem.

2) 69 year old patient 2nd post op for Prostate surgery. Doing well, no malignancy. C/o of being Short of Breath, staff put some oxygen on him.And went no further. Next check he was dead from a pulmonary embolism. Hospital liability 0.

3)Lady 72 comes in with Pneumonia, started on antibiotics, started chilling ,temp went to 104. Tylenol was given but the physician was not called. She was septic, went into septic shock, got moved to ICU in the morning but shock was so advanced that all interventions failed. Hospital liability 0.

4) 69 year old lady, in an MVA. Had a fractured femur. Was admitted and scheduled for surgery the next morning. Checked at midnight, B/p was trending down and heart rate was trending up. Physician was not called. Dead at the 4 am check. Autopsy revealed a lacerated liver. Hospital liability 0.

It is like racial bias. It's not overt, It's not blatant and out there. Staff, especially younger staff has the attitude that if you are a no code that you are comfortable with the idea of your own death.

Because of over work, because of attitude, because of ageism, hospital staff is more likely to over look subtle signs of impending crisis.

I spent 10 years working in ICU, I had a young wippersnapper nurse actually state "What are they doing in my ICU, they are a no code". I snatched her into a conference room and bawled her out.

No Code is supposed to mean no heroic measures. Increasingly it is being used to mean No Concern.

I know your heart is in the right place.

If you have a terminal illness, an Advanced Directive might be in your best interest.

If you are in good health but just getting older and there are things that you do or don't want, you are far , far better off having a very frank discussion with someone not in your immediate family and with no financial interest and preferably with extensive medical knowledge.

Sign a durable power of attorny for medical decisions only.

There are many things that can happen that are not lethal, and something like a ventilator can be a temporary bridge to recovery.

Judging by the way you write, I am assuming that we are about the same age.

We came up in a generation that had respect for life.

I am not being very adroit in explaining there is a huge difference between the care you get from a older nurse than you get from a younger one.

Younger nurses are very skilled and knowledgeable about the science and art of nursing. There is something lacking in many of them as humans.

A nurse 25 year old, has never lived in a world where abortion was not available on demand. They have only lived in a world where the enlightened Europeans were practicing euthanasia. Since schools of nursing are in "liberal" institutions even in nursing they are indoctrinated.

I know the difference between a Living Will, A No Code, What an advanced directive is.

The average age of a nurse is 50. Increasingly , the old fossils like me are leaving nursing and the youngsters are taking over.

I am fearful now of the quality of care in hospitals. I am dreadfully afraid of what it is going to be like in 20 years when I am in the group of retired.

My best advice. Get your living will and keep it secret from the hospital. Give it to your spouse, your lawyer, your neighbor, but not the hospital.

If the time comes where it is actually called for, then bring it out.

Thanks for your kind remarks.

I used to be a big supporter of living wills when they first started being discussed.

It seemed right and proper that people should have a say so in what happens to them at the end of their lives.

Then the Law of Unintended Consequences kicked in.

If you have a terminal illness they still may be a good thing.

However there are many many things that can happen that are temporary set backs and are completely correctable.

It is far more likely that you would experience a post OP Mi, a cardiac irregularity, a minor pulmonary embolis, a DVT, pulmonary edema, than it is to have a lethal occurrence.

There is no reason for a fatality for a non-lethal situation.

A Living Will/No code status greatly increases your chance of death from correctable situation.

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