Frank Talk About The End Of Life

Though it is human nature to avert the mind’s eye from the end of our lives, the media’s fixation on the life and impending death of Terri Schiavo this week has forced most us to think about our own mortality and how we want life to end. Give us our last day at home with loved ones close by, and with their friends and families surrounding them with comfort, understanding, and support. Spare us the politicians, lawyers, and protesters with placards.

Whatever your position on all the political and legal wrangling that has swept up Terri Schiavo and her family — and it is difficult not to feel sympathy for both her husband and her parents — it should be clear to all that something has gone drastically wrong in this case. It is frightening to have so many opinionated and powerful people, editorialists included, who never met Terri Schiavo and who know so little about her medical condition and even less about what her wishes might be for her own life and death, speak with such certainty and conviction about what is best for her, and by extension, for the country as a whole. This is a private matter best approached through love, compassion, and informed reflection.

Of course, this case started out that way. It only ended up in Florida’s state courts, and eventually in Congress and the federal courts, because there was no clear directive from Terri Schiavo herself. She was like the vast majority of Americans who have never clearly stated a preference for how end-of-life decisions should be handled for them. We expect the experience of the Schiavo family will inspire a resurgence in the popularity of living wills, which may help us put our minds to rest. But medical researchers say living wills, on their own, are largely ineffective.

A medical research scientist and a law professor from the University of Michigan co-wrote a paper that appeared in the current issue of the bioethics journal The Hastings Center Report that concludes that living wills routinely fail to predict the wishes of patients at the time they are invoked. After reviewing hundreds of studies on the effectiveness of living wills, the researchers discovered that end-of-life decisions change dramatically as an individual’s health declines. It is impossible to predict what we will want in entirely unpredictable situations. The medical research scientist, Dr Angela Fagerlin, told HealthDay, the Norwalk-based health news outlet, that studies have shown that “two-thirds of people say ‘I don’t really care how closely [a living will] is followed.’ They just want the person they trust most to make these decisions.”

For this reason, granting durable power of attorney for health issues is as effective a tool as a living will. Durable power of attorney is when you give another person legal authority to act on your behalf, even if you become incapacitated. We all know the one person we trust the most. In combination with a clear end-of-life directive, and frank direct discussions with loved ones, this legal instrument can be your family’s best safeguard against the gross intrusions on privacy and personal dignity that we have seen this week in Washington and Florida.

As we say, this is a private matter. Take it up with your family and your own attorney soon.