Planning for Dying Wishes

What a 25-year-old may consider unbearable may change when he's 35 or 40. "The bull looks different once you step into the ring," Sabatino said."

He suggests reviewing your living will or advance directive -- or simply having another conversation with your loved ones -- when one of what he calls "the Five Ds" occur: a decade goes by, or there is a death in the family, a divorce, a diagnosis of a serious illness or a decline in your health.

Efforts to Keep Individual in Control of Care

Sabatino said there's been a trend toward simplifying legal requirements for living wills and developing a procedure or form that would be valid from state to state.

"Legislators can help by getting the legal barriers out of the way. States have a lot variability about witness requirements, and 11 or 12 states require mandatory phraseology specific to their state," he said.

He also pointed to successful efforts by physicians in Oregon and Washington state to standardize a process for health-care providers dealing with terminally ill patients who may require life-sustaining treatment. Through the initiative, Physicians Orders for Life Sustaining Treatment, or POLST, physicians would ask patients questions about resuscitation, nutrition and hydration, antibiotics, and palliative care, and attach the questionnaire to a patient's medical file.

The questionnaire would travel with the patient, so future physicians who may treat the patient would have access to the information. West Virginia has adopted a similar program to help standardize the process for health-care providers.

All of these efforts are aimed at keeping the individual in control of his or her care at the end of life.

Individuals need to consider end-of-life care while they're able and share their wishes and their values with their families, said Dr. Sean Morrison, a geriatrician at New York's Mount Sinai Medical School. What makes life worth living? What would be a fate worse than death for me? "These are questions we need to answer for ourselves, and we need to communicate the answers to our families," he said.

Morrison finds the external intervention in the Schiavo case deeply troubling. "We have a right to say what is done to our bodies, whether we are able to voice our decisions or not. And courts have consistently upheld that we do. It terrifies me as a physician that outside bodies could come into these terribly intimate decisions that families and physicians face and influence the care a patient receives -- or does not receive. It disturbs me greatly," he said.

In cases like Schiavo's, Morrison said, "We're really talking about medical intervention to prolong death. We're not talking about prolonging life."

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