Living will, durable power of attorney are useful tools as life comes to an end

By LORETTA FULTON Senior Staff Writer

Misconceptions and lack of information are the two biggest obstacles standing in the way of widespread use of advance directives, experts in the field say.

For that reason, the goal of the bioethics committee at Hendrick Medical Center for the next year will be education, said Cheryl Livengood, a registered nurse and program manager in the case management department at Hendrick.

"We will focus on fostering community education," she said.

Specific plans aren't firm yet, but they include bringing in ethicists to conduct a symposium, better use of the media, and distribution of materials at Hendrick Place, an information center in the Mall of Abilene.

Also, members of the hospital's bioethics committee will be encouraged to speak to civic and religious groups.

Even though hospitals and other health providers have been required since 1990 to inform patients of such tools as living wills and a durable power of attorney, the message just isn't getting out, Livengood said.

Hendrick, like most hospitals, issues new patients a booklet which explains their rights and includes forms for a living will, durable power of attorney, and a uniform donor card.

Neither the living will nor the durable power of attorney requires preparation by a lawyer. The forms only need the signatures of two witnesses.

Most professionals urge use of both. Living wills only become effective when two physicians certify that the patient's illness or injury is terminal and that life-sustaining procedures would only serve to artificially prolong the moment of death.

"It helps make your wishes known if you're not able to speak for yourself," Livengood said.

A durable power of attorney gives the agent specified by the patient the authority to make all health care decisions when the patient is no longer capable of doing so, whether or not the patient has been deemed terminal.

Even so, that may not be the end of the discussion.

"If the physician just really disagrees, that's when you can go to the bioethics committee," Livengood said.

At Hendrick, the 15-member committee meets monthly and is made up of physicians, nurses, ministers, case management workers, and a risk management specialist.

"They try to help work through the quandary," Livengood said.

At Hendrick, at least, it is rare that the committee would have to make a recommendation on a life-and-death issue, Livengood said. She estimated that the committee, which serves a 350-bed hospital, hears such cases only once or twice a year.

And, she emphasized that the committee only makes recommendations, not decisions. If the patient has appointed an agent through a durable power of attorney, "they're going to have the final say," Livengood said. "Physicians are recognizing a person's right to self-determination - they are more accepting of that," she said.

She gave as an example a case involving a woman who had written a vague letter some years ago about her wishes. It was not a legal document, just a note she had written.

The physician disagreed with the woman's family about taking her off life-sustaining equipment, and the matter was taken to the bioethics committee, which recommended that the doctor "strongly consider the family's wishes," Livengood said.

The physician concurred and ordered removal of the equipment; however, before that could be done, the women opened her eyes and a decision was made to keep her on life-support, and she died about two months later.

Livengood said a patient's agent, whether family member or trusted friend, may eventually face a troubling dilemma: "What is prudently allowing a patient the right to die and what is passive euthanasia?"

A tremendous gray area exists that is difficult for everyone involved.

"There are no clear cut answers," Livengood said. "That's why we have bioethics committees."