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The Wall Street Journal, June 29, 1990, p. C1
Planning a graceful death doesn't rank at the top of anyone's list
of fun summer activities, but Monday's Supreme Court ruling on
the "right to die" has got a lot of people thinking about it.
By emphasizing the need for "clear and convincing" proof of a
patient's wishes, the ruling is likely to encourage greater use of
so-called living wills. These allow people to spell out in advance
their wishes about being kept alive indefinitely if they fall victim
to some severe and irreversible condition.
"We've received thousands of calls," says Fanella Rouse, executive
director of Concern for Dying/Society for the Right to Die. "There's
something about this decision that has really mobilized people to
think about the need to put their wishes in writing."
The Supreme Court case involved Nancy Cruzan, a 32-year-old
Missouri woman who has been unconscious since a 1983 car
accident. Her doctors say there's no hope she will ever recover,
and her parents have asked that life-support systems be
disconnected. They say she had expressed a desire not to be
kept alive after a serious injury if she couldn't function normally.
In its ruling, the court recognized for the first time that the
Constitution protects a person's decision to refuse artificial
life support. But, upholding a lower court's rejection of the
parents' request, the justices said the states may require a
high standard of proof of a patient's wishes.
For people who are worried that they may someday be kept alive
in a vegetative condition against their wishes - and at potentially
enormous cost - a living will is essential, say lawyers, doctors
and others who counsel individuals and their families on patients'
rights. Already, says the American Medical Association, an
estimated 15% to 20% of adult Americans have written a living will.
"It's rising exponentially," says Linda Emanuel, a physician who
has discussed living wills with hundreds of patients at
Massachusetts General Hospital in Boston. "It's almost a fad,
but a fad I approve of."
The key to writing a successful living will is using explicit
language. Your wishes have to be stated in a way "that your
intent will later be judged sufficiently clear by people taking
care of you," says Ms. Rouse. For example, if an individual
specifies that he doesn't want to be kept alive if he's in a
"terminal" condition, he should indicate what he means by
"terminal," since doctors interpret the word differently.
Society for the Right to Die has living-will forms for each state.
They are available by writing to the organization at 250 West
57th Street, New York, N.Y. 10107.
Other sources of living-will forms include local senior centers.
While individual lawyers can also help with a living will, some of
them say it probably isn't necessary to spend the money, since
the forms are designed to be used without legal assistance.
It would probably make more sense "to fill them out by yourself,
after discussing them with your doctor," says Dr. Emanuel.
An advantage of this is that people can then have their living
wills entered into their medical records, which can be available
immediately if they are brought in for treatment. Doctors also
recommend that a spouse or next of kin be given a dated copy.
Dr. Emanuel and some others say that people shouldn't rely solely
on a basic living will. To help ensure that a person's wishes will be
clear enough to be effective, they advise attaching a "medical
directive."
Dr. Emanuel and her husband, Ezekiel Emanuel, a physician at
Boston's Beth Israel Hospital, have developed a suggested
directive. It sets out four scenarios and allows people to specify
the treatment they would want in each case.
The form combines a living will with a durable power of attorney,
which enables a designated guardian to manage the patient's
finances and legal matters while the person is disabled. It also
includes a section for organ donation instructions and a personal statement.
"The personal statement allows people to say something extremely
important to them" and put their choices in a larger context, says
Linda Emanuel. For instance, she says, someone might emphasize
that the most important thing to them is their independence, or
sparing their family financial and emotional hardship.
The form can be obtained by sending a self-addressed, stamped
envelope and $1 to The Medical Directive, Harvard Medical School
Health Letter, 164 Longwood Avenue, 4th floor, Boston, Mass. 02115.
Even if an individual has already written a living will, it's important
to review it periodically. "You might not feel the same way at age
60 as you did at age 30," says Ms. Rouse, "and your interests might
also change in light of new medical discoveries."