Advance directives becoming very common in community
Whether it's a living will, advance directive, or durable power of attorney, the Terri Schiavo case in Florida illustrates all too well the importance that everyone make their wishes known regarding whether they wish to be resuscitated.
Storm Lake caregivers agree that when individuals make those decisions themselves, they prevent their loved ones and medical personnel - or the courts - from having to determine whether life should continue.
The Schiavo case presents some fairly unique difficulties in the euthanasia debate. As Lynn Radke, a nurse case manager at Storm Lake Area Hospice observes, "You have a feeding tube which in itself is an artificial means of sustaining life." Once a feeding tube is in place, though, removing it takes on a different dimension, Radke said.
Schiavo's case follows within days the death sentence given to Scott Peterson, the California fertilizer salesman convicted of murdering his wife, Laci, and their unborn child. What the two cases have in common is that they are bookends in determining the parameters of right to live or die issues.
Right-to-Life proponents heralded Peterson's conviction as a victory since it defined "personhood" for an unborn fetus. With his double-murder conviction, Right-to-Lifers say the courts had defined a fetus as a person with certain inalienable rights, namely the right to life. The U.S. Supreme Court majority opinion in Roe v. Wade explicitly stated that it chose not to define when life begins, the fundamental point of disagreement in the right to life debate.
At the other end of the spectrum, the claim by Michael Schiavo, Terri's husband, that she did not want to be kept alive artificially before she apparently suffered irreversible brain damage after her heart stopped due in an alleged incident relating to an eating disorder, is not backed by his wife's written directive.
Florida courts and the 11th U.S. Circuit Court of Appeals have ruled against the Schindler family's attempts to get their daughter's feeding tube reconnected after it was removed last Friday, creating a national furor.
Florida Governor Jeb Bush and the Florida social services have filed a petition in state court to take custody of Schiavo. The U.S. Supreme Court earlier refused to hear the case.
Removing he feeding tube to many is a case of active euthanasia, much like a lethal injection only taking more time. Others point to the fact that Terri Schiavo had apparently made her wishes known to her husband and so it is his right, even duty, to carry those wishes out.
Regardless of the position one holds, making one's wishes known to family and medical caregivers is essential.
"We always ask patients when we admit them" as to their wishes regarding efforts to revive them, said Radke.
"It's definitely blurry," she said of the Schiavo case. "As each day goes on we find out more and more about the case. It's hard to know about people's wishes. What's especially troubling is that it (Terri Schiavo's wishes) is not written down."
If there were no other major health issues posing an immediate threat to life, "It would be hard to say let's remove that feeding tube," Radke said.
"It certainly brings to the forefront that we need to come to grips with how we want our death to be or not be," Radke said.
Radke said everyone, regardless of age, should have some advance directive plan in placed with loved ones.
"Definitely," said Joleen Brady, social worker at Methodist Manor, in agreeing with Radke's position on advance directives. "That's a very good idea at any age."
Brady said advance directives and other issues are among the standard procedures that she discusses with residents and their families as new people are admitted to the skilled-care facility at Methodist Manor.
"We do discuss that on every admission," Brady said. She advises that those advance directives should be in writing.
"If it's done verbally it's hard to prove what your wishes were," Brady said. "We also encourage them (residents) to give copies to their doctor and hospital."
Brady estimated that 85-90 percent of residents at Methodist Manor had advance directives in place.
Laura Schaffer, social worker at Buena Vista Manor, said all but about 1 percent of residents at BV Manor have some advance directive or living will plan in place.
Schaffer outlines several levels and forms of designations that people might have. They include a general power of attorney for banking and other purposes, a power of attorney for health care decisions, and a separate living will in which the designated party would determine whether the designee would be hooked up to a machine. Schaffer advised that a person makes his or her wishes known to a doctor.
Schaffer said a power of attorney could clarify whether the person would allow invasive procedures, such as surgery or chemotherapy. A do-not-resuscitate order, as defined at Buena Vista Manor, indicates that the person does not want a staff member to administer CPR if that person's heart stops.
Schaffer said every resident's orders are reviewed quarterly to allow the residents to decide whether they want to change their minds.
"Whatever they choose, we're responsible for reviewing that," Schaffer said.
Viewing the Schiavo case as "borderline", Schaffer said she does not believe a do-not-resuscitate order means that comfort measures such as food and oxygen would not be rendered to the person. In other cases, a living will might state that a person does not want a machine to control that person's breathing.
Schaffer said there are a large number of people on feeding tubes. "It's not an uncommon procedure at all," Schaffer said. "To not feed somebody isn't right."
Schaffer said she ensures every resident entering Buena Vista Manor is informed.
"Pretty much everybody has that," Schaffer said. "I've been pretty vigilant about that. It's important to know who's making those decisions" for the medical caregiver.
Schaffer also agrees that living wills and powers of attorney are not just for the elderly or chronically ill.
"Everybody should have one because we don't know what tomorrow's going to bring," Schaffer said.