Living Wills. The insane controversy over the no-longer-human vegetable Terri Sciavo has had one beneficial effect: it has made people think about living wills and other instruments, such as a durable power of attorney, that could prevent such controversies by eliminating uncertainties as to one's wishes in similar circumstances. WebMD.com offers a useful discussion of these instruments that was hilited on AOL today. A Google search for "living will form" produced various results, such as http://www.peopleslawyer.net/willform.html, which contains form language, and this one, which discusses the whole process: http://www.uslivingwillregistry.com/forms.shtm.
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It seems to me that Government has a legitimate interest in preventing the kinds of swirling controversies this entire society has suffered, and the potentially catastrophic cost to families and preposterous costs to health insurance plans, Medicare, Medicaid, and charitable institutions of unwarranted "heroic" medical measures. Government can do this by actively promoting the use of living wills, standardizing them, making them generally available, and governing the way they are used by healthcare providers.
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As a first step, the Federal Government should establish a standard form for a combination living will and durable power of attorney for medical purposes, and require all states to abide by the directions given in such an instrument. That is necessary because people travel, and can have an accident, heart attack, or other life-threatening medical emergency anywhere in their travels. But at present, different states have different requirements and do not feel themselves bound by forms that are accepted in other states. That's preposterous, and somebody needs to crack the whip over all medical caregivers, in the entire country, to require them to abide by a universal standard form.
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The Federal and State governments can as well require the filing of a living will for each and every one of their employees, in civilian and military services, as a condition to employment, since the Government may be required to provide care to any employee who suffers a medical emergency on Government property, and by far most would be covered by a Government health insurance program. Such a health plan could, absent a clear indication that no heroic measures are to be taken if they cannot be expected to bring a person back to a real life, be stuck with hundreds of thousands of dollars of costs that other Government employees, and ultimately taxpayers, will be required to cover, for no good purpose.
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Second, since end-of-life issues can be expected to arise in any given year for a significant portion of the elderly, the Social Security Administration should require that before anyone receives so much as one cent from Social Security or Medicare they must file a living will with the Social Security Administration or another centralized national registry (see below), which will make it available to any hospital anywhere that is faced with a question of what a patient's intentions are.
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Third, recipients of public assistance (welfare, Social Security supplemental income, unemployment, etc.) should be required to complete and file a living will as a condition to receiving public assistance.
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Fourth, every adult, of every age, should be encouraged to write a living will, file it with the appropriate authorities (locking it in a safe that no one but you has access to is not good enuf), and keep it up-to-date. Government can promote this as it promotes voter registration, by offering standard forms at motor-vehicle departments, post offices, and other Government facilities people go to periodically.
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Fifth, employers should encourage their workers to create a living will, and should make a standard form available to them, (a) in printed form with blanks and instructions to cross out unacceptable provisions, (b) in the form of an electronic file the employer can revise on his/her own, or (c) by telling them the URL of a Government website where they can find a form to download for their own use. Further, employers should provide word-processing and/or Internet access for this purpose to workers who do not already have them. If a worker doesn't know how to print a blank file from the Internet or save a filled-in form and print it, someone in Human Resources should do that for him.
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In any case, filling out such a form should be done in private and the completed form should be filed with an appropriate Government agency or central repository to be set up or regulated by Government, not with the employer.
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There apparently already is a registry, but it is privately held, and I don't know whether it is a legitimate public service or a profit-making venture. We need a single, not-for-profit, national registry, be it under the auspices of Government or of a coalition of medical associations, legal associations, consumer advocates, etc.
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Sixth, doctors and hospital admissions desks already encourage people to give them a copy of any living will (sometimes called "advance directive") they may have. Healthcare providers also have their own forms relating to heroic measures. But people who come to a doctor for any condition, not just a serious condition such as might require major surgery, should be encouraged to make out a living will, which can be made available in printed form at each doctor's office. One must bear in mind that even apparently trivial medical procedures can produce catastrophic results. For instance, an allergic reaction to a local anesthetic, overreaction to general anesthetic, or even an allergic reaction to a commonly prescribed medicine could plunge a person into a life-threatening situation.
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Seventh, schools and colleges should popularize the use of such forms, and offer to students and both teaching and nonteaching staff blank forms or the path to the website where a standard form resides, along with free Internet access and the means to print such forms.
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Eighth, tho children under 18 are usually under the control of a parent or parents (or a guardian), they should nonetheless have the right to indicate, in writing, their preference as to which parent's decision controls in the event of a disagreement between parents. If kids do not trust parents from whom they are estranged, they should have the right to designate another adult they do trust: an uncle, aunt, grandparent, neighbor, teacher, priest — whomever.
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Ninth, there are self-emancipated children under the age of 18 who should also have the right to predetermine their medical care by means of a living will.

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I of course do have a living will, since I have had major knee surgery under general anesthetic and am 60 years old. Do you?
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(The current U.S. military death toll in Iraq, according to the website "Iraq Coalition Casualties", is 1,528.)

- posted by L. Craig Schoonmaker @ 2:12 PM