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Health Care Decisions Day: A time to write down your final wishes

POSTED: April 25, 2008 5:01 a.m.

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In the old days, you didn’t have to explain to anyone how you wanted to die. When your time came, you stopped breathing and that was it.

But with modern medical technology, a person can be kept alive almost indefinitely with no hope of recovery. And doctors will continue to maintain that life unless they’re instructed otherwise.

That’s why it’s so important to put your final wishes into writing. Wednesday has been designated National Health Care Decisions Day, to encourage people to fill out an advance directive.

"The first advance directive was the living will," said Rhonda Rogers, social services coordinator for the Hospice of Northeast Georgia Medical Center. "Then there was the durable power of attorney for health care. As of 2008, we have a new document in Georgia that is much more simplified."

The new advance directive can be downloaded off the Internet for free. It does not require the services of a lawyer and does not even have to be notarized, yet it is legally binding as long as it is signed by two witnesses.

The Hospice of Northeast Georgia Medical Center is one of the many organizations that are trying to make the public aware of this document. All week, the hospice will answer phone calls to help people with advance care planning.

In addition, the hospice has advance directive forms available, and can help people fill them out.

Similar services are also offered at Legacy Link, the Area Agency on Aging in Gainesville.

Rogers said everyone, not just the elderly or terminally ill, should have this information written down.

"It’s a misconception that only old people need an advance directive," she said.

The truth is that a person can be perfectly healthy one minute and near death a few seconds later. Rogers said young men, who comprise the demographic most likely to suffer a sudden catastrophic injury, are also the least likely to seek an advance directive because they don’t believe anything will ever happen to them.

When something tragic does occur and the person never expressed their wishes, the resulting uncertainty can tear a family apart. That was made clear in the case of Terry Schiavo, a Florida woman who suffered a cardiac arrest when she was in her 20s.

Oxygen deprivation left Schiavo in a "persistent vegetative state" from which she could not recover. Her husband wanted her feeding tube withdrawn; her parents insisted she could get better. The two parties fought a lengthy, highly publicized legal battle right up until Schiavo’s death in March 2005 at age 41.

The courts consistently sided with the husband, who contended that Schiavo once told him she would not want to be kept alive under such conditions. But the case never would have gone through the legal system at all if Schiavo had written an advance directive.

"If you don’t have one, the decision-making defaults to your family," said Dianne Currans, health programs manager for Legacy Link. "If you have this document, it’s all there in black and white, and the family can’t argue over it."

The Georgia Advance Directive has four sections. Part One allows you to designate a "health care agent," a person who will make health care decisions for you if you are unable to do so.

Part Two spells out your treatment preferences if you are incurably ill. You can choose to be kept alive by any means possible or to have no intervention at all. You can also choose to have certain types of support but not others (for example, feeding tube, fluids, ventilator, CPR).

Part Three lets you appoint a guardian, who will handle all of your affairs, not just health care, if you are incapacitated.

Part Four requires signatures from you and two witnesses. A witness cannot be anyone directly involved in your health care, nor anyone who might benefit financially from your death.

Rogers said as long as the form is signed, it is legally valid even if only part of it is filled out.

"There’s nothing that binds you to having to fill in every blank," she said. "These are very complex decisions."

Rogers said some people worry that if they fill out this form, no one will attempt to save their life in an emergency situation. But the document is only applicable once the person is in the hospital and is diagnosed with a permanent, irreversible condition.

"If you’re in an accident, emergency personnel will always treat you at the scene, regardless of your advance directive," Rogers said.

Currans said it does no good to have an advance directive if no one is aware of its existence.

"Give your doctor a copy, give your family a copy, take a copy with you when you travel," she said.

Rogers said the advance directive is the only way to make sure your final wishes are carried out, and it can also ease the burden on your family.

"The written document provides the (health care) agent with guidance," she said. "There’s no potential guilt about whether they made the right decision."



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