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You may need a ‘Will to Live’ as opposed to a living will


NASHVILLE, Tenn. (BP)–It may not be wise to have a living will but, instead, a “Will to Live,” as the National Right to Life Committee describes it.

The concept of a living will was aired in various reports about the tragic court-approved dehydration and starvation that led to Terri Schindler Schiavo’s death March 31.

A typically worded living will may not respect the beliefs of a pro-life Christian, according to the National Right to Life Committee and the Christian Medical Association.

It’s important to be specific about your end-of-life wishes, they say.

Burke J. Balch, director of the NRLC’s medical ethics department, noted in a commentary on the right-to-life organization’s website, “Denial of food and fluids to people who cannot speak for themselves has been going on for 15 years in this country. It is routine practice in hospitals and nursing homes across the country…. Only in the comparatively rare cases when there is some dispute among relatives [such as the Terri Schiavo case] do these cases reach public attention, normally in the context of lawsuits.

Legal surrogates such as the closest relative or a guardian, or in some cases, even the person’s doctor “are daily authorizing the cutoff of food and fluids to patients who are unable to speak for themselves and never gave any indication that they might want to be starved,” Balch reiterated.

David Stevens, executive director of the 17,000-member Christian Medical Association, said in a statement after Terri Schiavo’s death, “If anything remotely positive can come of this tragedy, it will be a fresh awareness of the need for patients to protect themselves by designating a proxy who will stand up for their clear desires in a case of incapacitation.”

Schiavo’s life was “unnaturally cut short” by starvation and dehydration that “led to a slow and painful death,” Stevens said.

Both organizations have posted documents on the websites by which people can stipulate a pro-life approach to their care if they become incapacitated.

At the National Right to Life Committee website, www.nrlc.org, click on “Will to Live.”

At the Christian Medical Association website, www.cmdahome.org, click on “Advance Directive.”

Schiavo had no living will but her husband’s-initiated court-approved death was strongly opposed by her parents and brother and sister for years, who felt Terri had been denied proper rehabilitation by her husband after a heart stoppage left her brain-damaged in 1990.

Balch noted that “the prevailing view in the judiciary, as in the medical profession, is receptive to the quality-of-life ethic [to sanction a death such as Schiavo’s]. Judges are often dismissive of our position that all human beings possess dignity and the right to live, regardless of their age or degree of disability.”

In fact, Balch added, “the current battleground is over efforts by health care personnel to cut off food, fluid and life-saving treatments from patients they think have a poor quality of life AGAINST THE WISHES of the patient and family. A large body of medical and ethical opinion holds that even when there is no doubt that a patient wants to live, or when family members are united in saying the patient should get life-saving treatment, doctors and hospitals should be able to say no.”

The Will to Live on the NRLC website has a specific link for each state.

For the state of Florida, for example, the Will to Live sets forth a “GENERAL PRESUMPTION FOR LIFE,” followed by sections by which a person can stipulate care for such circumstances as “WHEN MY DEATH IS IMMINENT,” “WHEN I AM TERMINALLY ILL” and “IF I AM PREGNANT.”

The “GENERAL PRESUMPTION FOR LIFE” states:

“I direct my health care provider(s) and health care surrogate(s) to make health care decisions consistent with my general desire for the use of medical treatment that would preserve my life, as well as for the use of medical treatment that can cure, improve, or reduce or prevent deterioration in any physical or mental condition.

“Food and water are not medical treatment, but basic necessities. I direct my health care provider(s) and health care agent to provide me with food and fluids orally, intravenously, by tube, or by other means to the full extent necessary both to preserve my life and to assure me the optimal health possible.

“I direct that medication to alleviate my pain be provided, as long as the medication is not used in order to cause my death.

“I direct that the following be provided:

* the administration of medication;

* cardiopulmonary resuscitation (CPR); and

* the performance of all other medical procedures, techniques, and technologies, including surgery — all to the full extent necessary to correct, reverse, or alleviate life-threatening or health-impairing conditions, or complications arising from those conditions.

“I also direct that I be provided basic nursing care and procedures to provide comfort care.

“I reject, however, any treatments that use an unborn or newborn child, or any tissue or organ of an unborn or newborn child, who has been subject to an induced abortion. This rejection does not apply to the use of tissues or organs obtained in the course of the removal of an ectopic pregnancy.

“I also reject any treatments that use an organ or tissue of another person obtained in a manner that causes, contributes to, or hastens that person’s death.

“The instructions in this document are intended to be followed even if suicide is alleged to be attempted at some point after it is signed.

“I request and direct that medical treatment and care be provided to me to preserve my life without discrimination based on my age or physical or mental disability or the ‘quality’ of my life. I reject any action or omission that is intended to cause or hasten death.

“I direct my health care provider(s) and health care agent to follow the above policy, even if I am judged to be incompetent.”

The NRLC document provides various suggestions for filling out the other sections for when death is imminent and for terminal illness.

For pregnancy, the form states:

“If I am pregnant, I direct my health care provider(s) and health care agent(s) to use all lifesaving procedures for myself with none of the above special conditions applying if there is a chance that prolonging my life might allow my child to be born alive. I also direct that lifesaving procedures be used even if I am legally determined to be brain dead if there is a change that doing so might allow my child to be born alive. Except as I specify … no one is authorized to consent to any procedure for me that would result in the death of my unborn child.”

The Christian Medical Association form, meanwhile, states under a section titled, “My Medical Treatment”:

“I believe that life is very precious, a gift from God. I deserve to be treated with dignity and respect. If I cannot speak or decide for myself, I want the following requests carried out:

“– All procedures directed by my physician should provide me with as much comfort and respect as possible.

“– I want to be fed and hydrated by mouth if possible.

“– I want to be kept warm and clean at all times.

“– I do not want to be in pain. My doctor should give me medication to control my pain, regardless of whether that makes me drowsy or whether I sleep more than normal.

“– If one or more physicians who have personally examined me reasonably believe that I am likely to die within 2 weeks as a result of a disease or illness despite receiving all appropriate medical treatment, then I want all burdensome procedures that would prolong the dying process to be withheld or withdrawn.

“– I forbid any form of physician-assisted suicide, euthanasia or any other action done with the intent of ending my life.

“– I want to be given food and fluids as long as I can swallow. If I am unable to swallow:

“(initial one)

“___ Artificial nutrition and hydration must be administered even when other interventions are withheld or withdrawn. OR

“___ Artificial nutrition and hydration should be administered according to the same guidelines as other life-sustaining interventions.

“– If my doctor and one other physician reasonably determine that my death is likely to occur within two weeks and life support will only prolong my death:

“(initial one)

“___ I want life support measures to continue. OR

“___ I want life support stopped or if it has not started, I do not wish for it to start. OR

“___ I want life support if my doctor thinks it will help, but I do not want life support if it does not improve my condition or help my symptoms.

“– If my physician and one other qualified physician familiar with my case decide that I am permanently and severely brain damaged (meaning I cannot speak, and cannot respond to my environment) and they do not expect my condition to improve and life support would only delay my death:

“(initial one)

“___ I want life support measures to continue. OR

“___ I want life support stopped or if it has not started, I do not wish for it to start. OR

“___ I want life support if my doctor thinks it will help, but I do not want life support if it does not improve my condition or help my symptoms.

“– If my doctor and one other qualified physician familiar with my case decide that I am in a coma, or that I am brain damaged and they do not expect me to wake up or recover and they do not expect my condition to improve, and life support would only delay my death:

“(initial one)

“___ I want life support measures to continue. OR

“___ I want life support stopped or if it has not started, I do not wish for it to start. OR

“___ I want life support if my doctor thinks it will help, but I do not want life support if it does not improve my condition or help my symptoms.”

The form then provides a section in which a person may specify “other conditions in which I do not want to have life support.”
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