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Nancy Cruzan, who prompted the Supreme Court's first
right-to-die case, lay in a vegetative state for eight years
before her parents received legal permission to withdraw the
feeding tube that prevented a dignified death. Such loss of
control over one's destiny is among the worst fears of the
very ill. But a new Federal law that will take effect late next
year will ease that fear.
The measure says that patients entering a federally funded
hospital or nursing home must receive written information
about state laws and their rights under those laws to refuse
treatment. They must also be given information about each
institution's practices so that they can choose an institution
that will agree to honor their wishes.
The Patient Self-Determination Act also requires institutions
to record whether the patient has, in writing, rejected life
support. Patients can do so in an "advance directive" - a living
will, say, or by designating a health-care proxy - that takes
effect once they're incapacitated.
Forty-one states have living-will laws; New York, which does
not, is among the 18 that allow health-care proxies. But living
wills can be unnervingly vague, and even the most conscientious
health-care proxy may be hesitant to make certain decisions.
The more precise patients can be, the better for them, their
families, their friends and doctors. Which is why there have
been so many requests - from individuals, physicians and
hospital administrators - for the medical directive set forth
by Dr. Linda Emanuel and Dr. Ezekiel Emanuel in the Journal of
the American Medical Association last year.
The form involves four sceanarios - persistent vegetative
state, coma with a chance of recovery, dementia and dementia
with terminal illness - and a choice of very specific interventions.
And it's meant to become part of the patient's file.
The form allows patients to specify treatment if they wish it;
requests may be affirmative as well as negative. But whatever
the choices, the important point is that they'll now be made by
the people to whom they matter most.