| BUSINESSWEEK ONLINE : MARCH 1, 1999 ISSUE | ||||||||
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| PERSONAL BUSINESS
A Plan for the Endgame Imagine suffering a stroke or being left in a coma as a result of an auto accident. Would you want to be kept on life support? Fed through a tube? Or given pain-controlling drugs, even if it hastened your death? You have the right to make these choices. But in most states, you must do so in writing. You'll need two documents, called advanced directives: A living will that tells doctors and hospitals how you want to be cared for should you become terminally ill; a health care proxy that designates an advocate who can make sure those wishes are honored. Says Jim Towey, president of the nonprofit group Aging With Dignity: ''People have to look at the endgame--and not just in terms of dollars and cents.'' TRAGIC GAP. Medical technology has made it possible to sustain life longer. But the rise of managed care and the threat of litigation has kept families and doctors from resolving these issues informally. ''Once, a physician would sit down with a family to discuss this,'' says Robert Arlen, a Boynton Beach (Fla.) estate attorney. ''Now, we deal in an environment where establishing that close relationship is difficult.'' When living wills don't exist, the consequences can be tragic. Hugh Finn of Louisville, Ky., talked to his lawyer about drafting a living will but never completed one. Then, in 1995, he was severely brain damaged in an automobile accident and spent three years in a persistent vegetative state. Last year, after his wife moved him to a Virginia nursing home to be close to his parents, she requested that his feeding tube be removed. Other family members objected, and the state of Virginia joined them. The device eventually was withdrawn, and Finn died--but only after an agonizing legal battle that tore his family apart. As a result of that case, some Virginia legislators are trying to restrict family members from making life-and-death decisions for patients who cannot choose for themselves. But in Florida, the legislature is debating a measure that would broaden the definition of terminally ill. It would give doctors more flexibility in granting a patient's wish to die. Living wills do not give a hospital the right to pull the plug without consent of a patient's legal representative. In most states, a decision to end life support requires the approval of two doctors, who must certify that there is no hope of recovery. Indeed, if you want doctors to exhaust every effort to keep you alive, no matter what, you can put that in a living will. ''You can say: 'I don't want anything done,' or you can say: 'I want absolutely everything,''' says Bethesda (Md.) attorney Marilyn Kressel. Lawyers say it is important to be as specific as possible. If you want morphine or other pain medication in your last days, even if it is addictive or makes you drowsy, say so. It's the same with life support. If you want it turned off if you are near death, write that down, too. Whatever its contents, a living will is one legal document that should not be kept in your safe deposit box. Give copies to your lawyer, your doctor, and your adult children, and take one to the hospital on your next visit. Putting your wishes in writing does not guarantee that a hospital will honor them, however. To make sure it does, you'll need to appoint a legal representative, usually a relative or friend, who can handle your health care decisions if you cannot. You make this choice by executing what's called a designation of health care proxy, health care surrogate, or medical power of attorney. You might want to make your spouse your representative. But think about giving backup power to an adult child if you are not sure that your spouse could handle such wrenching decisions at a time of great stress. ''Documents are great,'' says Kressel. ''But they have to be in the hands of an aggressive person.'' LOW COST. Most lawyers will do the paperwork for a living will at no cost if they are already preparing your estate plan. You can also get the necessary forms from nonprofit advocacy groups. Aging With Dignity (www.agingwithdignity.org) lets you download a free plain-English version called Five Wishes that's valid in 33 states. The group will mail you one for $4 if you send it a check to P.O. Box 1661, Tallahassee, Fla., 32302. Another organization, Choice in Dying, provides documents geared to specific states for $5 (800 989-9455, or www.choices.org). Working through end-of-life issues is no fun. But it sure beats forcing your family to make a decision in a hospital waiting room--or worse, having your last wishes ignored. By Howard Gleckman _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ BACK TO TOP |
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