WASHINGTON – State medical and legal officials are urging Marylanders to fill out a living will now, to avoid the problems that have put a Florida family through a years-long legal fight over the care of a brain-damaged woman.
The headline-grabbing fight over Terri Schiavo prompted Attorney General J. Joseph Curran Jr. last week to urge state residents to make decisions about their own care “before the crisis” by completing an Advanced Directive Form, one version of which is available on his Web site.
Maryland created a living will years ago with the Health Care Decisions Act, which made it possible for a person, prior to an injury or illness, to designate treatment preferences. The advanced directive also lets a person choose a caregiver who can make medical decisions should he be rendered unable to care for himself.
“The whole country is seeing the importance of it, and I hope that it will encourage people — really give them a sense of urgency — about stating what they would like,” said Jean Tucker Mann, director of patient care services at the University of Maryland Medical Center.
Mann, who is also co-founder of the center’s palliative care services, has seen the benefits of the advanced directive first hand.
“Having someone that they (the patients) trust and know” carry out their wishes makes the decisions during grief-stricken moments much easier on the families, said Mann, who has witnessed the quarrels that can otherwise arise.
Without written instructions, she said, people can claim they have verbal direction from the patient that others are not aware of. That can lead to fights between family members over the care of the patient — as has happened with Schiavo.
Terri Schiavo did not have a living will 15 years ago when she went into a persistent vegetative state, which is defined in Maryland law as “an irreversible loss of consciousness, despite reflexive nerve and muscle activity.”
Her husband insists she said she would not want to be kept alive this way. But her parents insist that she not be removed from the feeding tube that has kept her alive for all these years.
The husband and parents have been waging a high-profile legal fight over who has custody of the brain-damaged woman. That case reached all the way to Congress and the Supreme Court this month, when the husband finally won the most recent order to have her feeding tube removed.
Maryland’s living will allows a person to specify whether he would like to be put on a feeding tube to receive nutrition and hydration should he be diagnosed as terminally ill, in a vegetative state, or at the end-stages of a life-threatening condition.
Assistant Attorney General Jack Schwartz said Maryland is one of fewer than a dozen states that make such information readily available on the Internet. The Web page http://www.oag.state.md.us/Healthpol/adirective.pdf includes forms and information. on advanced directives.
The state forms are among the most comprehensive and thorough advanced directives in the country, but are still only a few pages long and straightforward.
“It was intended to be that way,” Schwartz said. “Lots of lawyers will tell you they can do a better job drafting it for their clients” but the state’s copy is very usable.
“The goal was to put documents out there that people could understand,” Schwartz said. “They generally serve their purposes very well.”
Even with a living will there can be disputes, he said. Parties could argue, for example, over whether a person is actually in a particular medical condition, like a coma or persistent vegetative state.
But filling out a living will provides a greater safeguard against confusion and grief over the care of a loved one.
And advocates say it’s not just a step for senior citizens to consider: Diane Tripplet, executive director for the Brain Injury Association of Maryland, said that most such injuries are sustained by people between the ages of 15 and 35. The group reported more than 5,000 traumatic brain injuries in Maryland in 2000, the last year for which it had figures.
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