Living wills help ensure a patient's wishes are followed

During the past two weeks, the Terri Schiavo case and her Thursday death have dominated national media outlets.

Local health care workers and attorneys hope Schiavo's plight will draw attention to solutions for resolving similar issues before they ever arise.

"I guess if there's one positive thing that comes out of this whole thing," said Lon Eliason, a social worker with hospice Home Options of Kalispell, "it's that it gets people thinking about advanced medical directives."

Advanced medical directives are any documents created to give family members, friends or physicians instructions on how the individual wants to be treated in a situation where he or she is unable to make or communicate those wishes.

Such documents are made before a person is incapacitated, so loved ones are relieved of making life or death decisions without input from the patient, Eliason explains.

Montana law recognizes two main documents related to end of life care: a living will and a power of attorney for health care.

A living will is a document that outlines the kind of care a person wants - or doesn't want - should he or she have a terminal condition.

For example, people can specify that if they are in a persistent vegetative state, as Schiavo was, that they be removed from feeding tubes and allowed to die.

A power of attorney for health care document allows a person to designate someone, such as a spouse or parent, to make medical decisions for him or her in any situation where the patient cannot communicate. Sometimes these documents are also called durable power of attorney forms.

Power of attorney designations apply to a wide range of health-care situations, such as if a decision needed to be made while a patient was under general anesthesia, but often are associated with end of life issues such as terminal diseases.

People can be very specific on their living wills about what kinds of treatments they want or don't want. Or they can be more general and simply say something such as they don't want heroic efforts that would only prolong life, Keedy said.

A general living will combined with nominating a power of attorney gives a designated loved one flexibility in making medical decisions as they come up or interpreting someone's expressed wishes, attorneys say.

If a person makes out both a living will and power of attorney document, one does not preclude the other. Instead both documents are used to guide loved ones and physicians in making decisions Keedy said.

"These are documents that make everybody's lives easier - the docs', the judges', the family members' the lawyers' - everybody," Kalispell attorney Bruce Measure said.

Measure carried the Rights of the Terminally Ill Act that outlined advanced medical directives while he was a legislator in the state House of Representatives in 1991. The law states hospitals or health-care workers cannot be held liable for following advanced medical directives, Measure said.

Attorneys often draw up living wills or health-care power of attorney documents for clients as part of general estate planning papers, but advance medical directives don't have to be done by a lawyer.

"You can do it yourself and that's fine," Measure said. "That's what the act was designed for."

Montanans can draft their own documents or they can fill out standardized forms widely available on the Web. Many organizations such as the National Hospice and Palliative Care Organization or legal sites have documents available for free downloading.

Once people fill out and sign such forms or write their own documents, the papers must be signed and dated by two witnesses.

The documents do not have to be notarized.

Some attorneys recommend people who often travel out of state have theirs notarized to ensure other jurisdictions recognize the documents should they become ill while outside Montana. Generally though, most states recognize documents signed by two witnesses even if they aren't notarized, Whitefish attorney Susan Lacosta said.

After the documents are completed and witnessed, give copies to loved ones and physicians, Keedy said. Above all, keep papers where they'll be accessible to someone in a crisis rather than locking the only copy in a safety deposit box, Measure said.

Kalispell Regional Medical Center asks all its patients if they have advanced medical directives, said hospital spokesman Jim Oliverson. If patients have them, they're kept on file at the hospital. If patient don't have the documents, the hospital can help them draft the documents.

Kalispell Regional Medical Center has available packets with information on and forms for both living wills and powers of attorney. Anyone can pick those packets up and give completed copies to their loved ones and physicians, Oliverson said.

North Valley Hospital also has packets available.

Montana law stipulates that if a person doesn't have either document, certain people can make medical decisions on their behalf when the person can't communicate.

Those people (in order that the state honors them) are spouses, an adult child or the majority of adult children, parents and siblings or the majority of the adult siblings.

Reporter Camden Easterling can be reached at 758-4429 or by e-mail at ceasterling@dailyinterlake.com