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Subject:  Re: Living Wills Don't Mean Much Date:  2/5/2007  9:14 AM
Author:  DorothyM Number:  327 of 117488

Living wills, which are better known in medical and legal circles as advance directives, state your preferences about the medical care you want to receive in the event you cannot communicate your wishes.

In most states, advance directives are instructions about when to stop providing life-sustaining medical treatment.

Here in Texas, the written directive forms ask you to choose between continuing or ending such treatment. But the state law does not force physicians to abide by those instructions.

"It is just a piece of paper that has to be interpreted and is subject to family disputes and conflicts," said Dr. William J. Winslade, a professor and medical bioethicist at the University of Texas Medical Branch in Galveston.

It's even more complicated than that. The living will says something like (in legal terms): "If I'm terminal this is what I want..."

The catch is that you have to be declared terminal by a doctor -- that they can do nothing more for you under normal circumstances (or something like that). Several years ago neighbor (and friend) had emphysema, late 70s, deteriorating. Didn't want ventilator or "heroic" measures, etc. Called 911 in middle of night, couldn't breathe, EMS inserted ventilator (standard procedure) - When the daughter arrived she asked that her mother be removed from ventilator (medical proxy and living will) - doctor (pulmonary specialist) refused. There was a chance the woman would recover/could be kept alive. Big fight -- doctor said that if they went to the ethics committee he would "win." (Sorry, but that's the word he used.) The woman was on the ventilator more than 2 weeks before it was removed and she died. This was New York.

When it became clear that my mother would not recover (as advised by a specialist who saw her at primary doctor's request), I went to the primary and requested that she be allowed to die peacefully and without further very difficult treatment, the primary readily agreed. But my mother was on the cardiac floor and her congestive heart failure had been "cured" and the pneumonia which had developed after admission had also been "cured." There were, of course, other issues which would result in her death. So in order to declare her "terminal" she had to be moved to a "General" floor and the next day we went to a hospice where she died a few days later, after antibiotics were stopped. My mother was a resident of Maryland, but was hospitalized in Wash. DC.

Copies of living will/medical proxy should be given to primary doctor and discussed with him/her. Any surgeon or specialist should also have these copies and the patient's wishes should be discussed in some detail. If the doctor you're seeing doesn't agree with what you want you need to get another doctor. Copies should also be in your file if you're admitted to a hospital, even for minor procedures.
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