How to avoid Terri Schiavo’s fate

How to avoid Terri Schiavo's fate By David Lias People who want to avoid the difficult emotional, legal and ethical circumstances currently swirling around Terri Schiavo can seek a rather simple remedy.

�At the very minimum, you ought to grab a napkin or a piece of paper and scrawl something out,� said Michael Myers, who teaches elderlaw and healthcare law at The University of South Dakota School of Law, �saying that you want the following ? but the best thing you can do is execute a durable power of attorney for health care, or a living will.�

According to news reports Thursday morning, Terri Schiavo�s parents have asked the U.S. Supreme Court to order the reinsertion of their severely brain-damaged daughter�s feeding tube.

The appeal by Bob and Mary Schindler � their fifth to the high court � caps a rush of legal activity in the unprecedented right-to-die struggle against their daughter�s husband, Michael, who has said his wife told him she would not want to be kept alive artificially.

Terri Schiavo�s feeding tube was removed last weekend after courts ruled in favor of her husband. He has argued that his wife would never want to be kept alive artificially.

�None of this would be going on today (had Terri Schiavo completed a living will),� Myers said. �If you said to Terri Schiavo when she was 22 years old, if you were to be confined to a bed for 15 years, kept alive by artificial nutrition and hydration, with a brain stem that allows you to breathe and your heart to pump, but a cortex that�s virtually gone, would you like us to keep you alive?�

By not formally putting her last wishes in writing, a court battle has ensued for years pitting Terri�s husband, against her parents.

�The court has listened to all of the evidence ? and the court concluded that it was in agreement with the natural next of kin, Michael, the husband,� Myers said, �and agreed with his decision, and ruled against the parents.�

�I�ve been monitoring the case pretty carefully,� said Timothy Tracey, CEO of the Sioux Valley Vermillion Medical Center. �Obviously, I think there are some real things that can be done by

people to avoid this situation.

�From our perspective as an organization, we place a great value on the sanctity of human life,� he said. �What we do promote is a better

understanding between the patient

and the health care provider so we can be respectful when it comes time to talk about things like end of life, terminal disease and those kinds of things.�

Like Myers, Tracey indicated that living wills and durable power of attorney documents should be considered by everyone.

�When reduced to writing, those are pretty hard items to trump or argue with in front of a court,� Tracey said, �because the person who executes those are the individual, and they get real specific in terms of removal of heroic measures such as respirators, feeding tubes and other types of apparatus to sustain life for people who are terminally ill or in a persistent vegetative state.�

Congress became involved in the controversy shortly after the feeding tube was removed March 18, passing legislation that would allow the tube to be reconnected while a federal court reviews the case. President Bush signed the bill March 21.

The following day, however, a U.S. District Court refused to order the reinsertion of the tube.

On March 23, the 11th Circuit declined to order the reinsertion of the feeding tube.

�This is politics with a capital P,� Myers said. �Florida, Jeb (Bush), and I don�t care what persuasion you are, either Republican or Democrat. There are 10,000 people in a persistent vegetative state in this country, and my guess is that if there is presumption of life, Congress is going to be awfully gal-dang busy, ruling on these 10,000 people.

�They�re going to spend a lot of time adjudicating, because I would imagine those other 10,000 lives are every bit as precious as Terri Schiavo�s is,� he said. �From a legal scholar point of view, this is an arrogant, presumptuous and unconstitutional invasion into the separation of powers. It may be bad law, but it�s damn good politics.�

Living wills and power of attorney documents are options available to South Dakotans after Congress passed the Patient Self-Determination Act in the wake two other rather recent right-to-die cases involving young women, namely Nancy Cruzan and Karen Quinlan.

�And then 47 states did what South Dakota did; they enacted the living wills statute,� Myers said, �for the precise purpose of avoiding this type of thing.�

The Patient Self-Determination Act obligates all hospitals or facilities that receive Medicaid or Medicare support to ask patients if they have living wills.

�If they do not, they are required to make available to you materials to execute that,� he said.

Myers urges people to either visit their lawyer or their local hospital, �and get a living will or durable power of attorney for health care, and fill it out.�

Both Sioux Valley Vermillion Hospital and the Sioux Valley Vermillion Health Care Center provide power of attorney and living will documentation to everyone who is admitted, Tracey said.

�We also provide some public education on living wills and power of attorney,� he said. �A lot of people think they are too young to do it ? but it�s a pretty easy decision to make when you are young regarding what kind of measures you want to have taken.�

�On admission, we ask for copies of the advanced directives,� said Veronica Schmidt, a social worker at the Sioux Valley Vermillion Health Care Center. �Those are reviewed, specifically for those who enter the care center. It is standard procedure that we review those documents with the family of residents, and we clarify whether their current wishes continue to be congruent with the living will.�

Schmidt said if there are changes in the health status of an individual at the center or hospital, �we revisit that living will once again as things are progressing further.�

For a living will to take effect, an individual must be both incapacitated and suffering from a terminal health condition.

A durable power of attorney gives individuals several options to more specifically define the type of end-of-life medical treatment they wish to receive.

People can choose to simply direct relatives and health care givers to follow instructions left in their living wills. They may also indicate that they are granting discretion to an agent, usually a spouse or close relative, who is given power to withhold medical treatment if the burdens of the treatment outweigh the expected benefits.

Most people, Myers said, choose to grant discretion to a loved one.

A durable power of attorney document also gives people options to specifically withhold or deny receiving medical treatment if they are suffering from an incurable or irreversible treatment, or if in a coma or persistent vegetative state.

There is a fourth option. One can choose a directive requesting maximum medical treatment, requesting that one�s life be prolonged without regard to condition, the chances of recovery, or the cost of the procedures.

�Annually, we�re required to do some type of education for some group of people on advanced directives,� Tracey said. That information is often shared with church or civic groups in the community.

�But I think this year, in light of this particular (Schiavo) case ? I think we will hold educational sessions with the public on advanced directives,� he said. �People can then take the documents to someone, execute them and make their wishes known.�

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