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from What are the lessons Terry Schiavo has taught us? That question is being asked by many, both personally and professionally, and the answers are as diverse as we are. This article outlines my reflections in the past several months. Everyone Experiences It:
Not the dramatic medical situation, the extreme family conflict,
the protracted legal battles, and the stunning political interventions
— those situations are rare. But
each of us shares the same underlying reality that pushed Terry Schiavo
into our lives. At some point
— whether we are new law graduates, sending our children off to college,
or of retirement age — sometime, somehow, someone else will be making
health care decisions for us because we can’t.
We may be briefly unconscious, or we may be suffering from
end stage dementia; we may have been in a traffic accident, or we
may have come to the end of a long battle with cancer. It doesn’t really matter why — it’s the inevitability
that should propel each of us to think about how we want those decision
makers to make decisions for us. Planning: A Gift to Yourself: Advance planning may be one of the greatest gifts one can give oneself, because it assists in living life to the fullest. Reflection on personal values, religious beliefs, spiritual connections, personal and family relationships, and financial circumstances — all necessary in advance health care planning — brings what’s important in living into sharper focus, as well being very useful at the end of life. Minnesota’s health care directive is a tool we can use to facilitate that personal reflection. And to Your Loved Ones: Terry Schiavo was like most of us: we haven’t taken extended time to talk with our loved ones and we haven’t designated our preferred decision makers. None of us can change the inevitabilities of life by not talking about them. Under applicable legal and ethical principles, even if we do nothing family members and other loved ones will likely make health care decisions for us, if they make them in our best interests and not in their own interests or in the interests of others. However, we have the opportunity to minimize the painful uncertainty our loved ones would otherwise suffer by clearly communicating our values and preferences while we are still able to do so. If we suspect there may be rivalry or conflict among our likely decision makers, we should clearly designate our preferred decision maker by appointing a health care agent in a health care directive, if only to minimize the risks of delay, litigation and publicity. We can compound our gift if we include expressions of our thoughts and feelings about end-of-life issues, even extending to guidelines for our funeral and burial. Our designated decision makers will still face the hard decisions and will still be stressed and stretched in times of crisis and sorrow. But they will at least have some confidence that they are doing what we would have wanted them to do. Health Care Providers Too: Our health care providers seek to provide us care and services to achieve our life goals within the context of what life has presented us. However, since our providers aren’t likely to have much opportunity to get to know us personally before we ask for their help, and aren’t likely to ever have as much time to spend with us as either of us would like, our advance planning is a gift to them which enables them, in turn, to serve us better. Potential Gift to Community: Some of us will be taken from this life with the opportunity to provide continued life and better health for others through organ and tissue donation, and/or by contributing our bodies for medical research purposes. Advance planning can make it easier for our loved ones to give that gift when they are called upon to provide consent. Not Rocket Science: Health care directive forms may appear daunting, but we shouldn’t let that stop us. A health care directive can be a simple written statement, such as “I, Mary Jones, want my sister Susie Smith to be my health care agent,” which is signed, dated, and witnessed or notarized. Or, a health care directive can be an in-depth expression of one’s life philosophy, suitable for publication as an example for others. It can be anything in between. Terry Schiavo taught us that expressions of values and
perspectives, even though short and simply stated, are powerful and
meaningful. Rather than waiting
to get it “perfect” and in the process losing our ability to say anything,
we and our loved ones are bette Talking It Through: A health care directive is a legal
document that is executed in the context of conversations with ourselves,
our loved ones, our health care providers, and ou No health care directive will ever address every detail of every situation our decision makers may find themselves in as decisions present themselves. What matters at decision points is the conversations and the relationships that were built during and because of the conversations, with the legal document providing general guidance and validation. Extremely Important People: Whatever one may think about the decisions made by Michael Schiavo, there are powerful lessons to be learned from his perseverance and fortitude. Our decision makers — whether they be court-appointed guardians, health care agents appointed in health care directives, or loved ones left to make decisions without a legal designation — may have to be assertive, if not actually aggressive, in advocating for us. Even if the decisions are not as controversial as they were for Michael Schiavo, we want our decision makers to be strong advocates for our wishes — not for their own wishes, not for those of other family members, and not for those of our health care providers. We would all do well to choose a strong health care agent carefully. Every personal and family situation is different. The best agent for one person may not be the best agent for another. The most common agent (the spouse) may not be a good agent at all, given the stress and sorrow the spouse may be feeling when hard decisions need to be made. And, we should not forget to consider our alternate agents: who would have been Terry Schiavo’s decision maker if Michael Schiavo had become unavailable? Form and Substance. Minnesota’s health care directive is, by design, a very flexible tool. It requires only six elements to be valid. It must: 1) be written; 2) name the principal; 3) be executed by a principal; 4) with capacity; 5) be witnessed or notarized; and, 6) name a health care agent, express health care instructions, or both. The form used is not nearly as important as the thought behind it, the conversations that accompanied its development, and its contents. The suggested statutory form or those suggested by other organizations are starting places. They can be tailored for personal expression by expanding them, contracting them, or taking an entirely different approach. Like any communication, the directive will be most powerful if it addresses the anticipated audiences in terms they are most likely to understand and respect. Keep Talking and Planning: When health care directives are executed, provide copies to those with potential to become involved with your decision making. By sharing our intentions early on, we can consider the input of others and make changes in our documents while we are able to express our wishes. Our health care agents, who will be charged with carrying out our wishes to the best of their ability, need to clearly understand and be as comfortable as they can be with what we are asking them to do. While our health care instructions, either written in a health care directive or provided in conversations with our agents and others, will never provide absolute certainty, our agents must at least feel that they have the general parameters of our wishes clear in their minds and hearts. It may also be prudent to share our desired approach to
health care decisions with those who may disagree with our wishes. By knowing and considering the perspective of
those who disagree, we equip ourselves to make changes, either to
accommodate thei Opportunities to discuss our wishes with our health care
providers should be seized whenever possible, so that as our relationships
with them develop over time, we can work through how they will recognize,
give respect to, support, and advocate for our wishes. The health care system is not as well-positioned
as it might be fo We should also investigate additional steps that may be
required to ensure that our wishes are respected in the othe We need also to investigate and implement a plan for emergency circumstances, such as a cardiac arrest at home. Even if we have written in our health care directive that we don’t want cardiopulmonary resuscitation (cpr) in the event of a cardiac arrest, a health care directive or even a health care agent telling the emergency medical personnel to stop cpr will have no effect, unless certain protocols are followed. Continue thinking About It. We all change our thinking as we age and as our life circumstances change. What we think we want for ourselves when we are 25 may not be what we think when we are 50, or 80. We may come to entertain ideas that would have been impossible to consider even as few as five years ago. The people we may have designated to make decisions for us may no longer be as close to us, may have moved on, or others may have taken their place. Whether we have executed a health care directive or not, periodically reviewing and refining our thinking on the subject and comparing our conclusions with what we’ve communicated to our loved ones is essential as time moves on. Conclusion: Starting may seem difficult. However, not to have started is much more likely to end up being the most difficult, especially for our loved ones. For further information regarding both the applicable law and the process of composing a health care directive, see the following resources: Minn. Stat. Chapter 145C, Health Care Directives Minn. Stat. §525.921, et seq., Anatomical Gifts Minn. Stat. §149.80, Funeral Directive www.mnbar.org — The Minnesota State Bar Association has the statutory suggested health care directive form on its Web site. www.abanet.org/aging — The American Bar Association has many helpful resources. www.hospicemn.org
— Hospice www.mnaging.org
— The Minnesota Board on Aging has a suggested health care directive
form and worksheet developed by the www.health.state.mn.us
— The Minnesota Health Department offers Questions and Answers about
health care directives. This
article is dedicated to my parents, Leo and BARB BLUMER has been practicing with Orbovich
& Gartner Chartered in |
