New Law On Living Wills Examined At Medical Town Meeting

DANBURY — A new law took effect in Connecticut in October that broadens the use of advance directives and living wills in the state and promises to help eliminate confusion.

The new law states that previously made advance directives remain valid; that living wills can now include any aspect of health care, not just end-of-life; and that a document becomes effective only when a person cannot speak for him- or herself.

The new changes in the law were explained by Daniel O’Hare, PhD, an ethics consultant to Danbury Hospital, at a recent Medical Town Meeting, “Updating Advance Directives and Palliative Care,” at Danbury Hospital.

Dr O’Hare, a professor of ethics at New York Medical College in Valhalla and Fordham University in the Bronx, spoke along with Julie MacMillan, RN, a nurse in the hospital’s Intensive Care Unit and co-chair of the hospital’s Ethics Committee, and Karen Mulvihill, RN, APRN, coordinator of the inpatient CARES program. Jan Mashman, MD, Department of Medicine, Section of Neurology, and co-chair of the Ethics Committee facilitated the Medical Town Meeting.

The problem with the way advance directives were handled, according to Dr O’Hare, was that they could be confusing. Because there was no uniformity of the law between states, it was not clear whether a living will made in Florida, for example, was valid in Connecticut.

People did not know what was legally binding, and how these documents could be executed, he said.

Today, however, the state makes it clear that documents made in other states are valid in Connecticut.

In addition, he said, there is a lack of public awareness of the importance of an advance directive or a living will, noting, “Fewer than 18 percent of people have one.”

An advance directive is a legal document through which a person may provide his or her directions or express preferences concerning medical care. It also allows the person to assign someone to act on his or her behalf in the event the patient is  unable to speak for him- or herself.

A living will is a document that states a person’s wishes during any kind of heath care. If a person is unconscious or terminal, the living will tells physicians whether the patient wanted life support systems to keep him or her alive. A living will takes effect when the person can no longer communicate.

“These documents maintain a person’s voice in the decisionmaking,” said Dr O’Hare. “It’s a gift to the family and surrogates, a guide to all care providers, and a goal to have a person’s wishes heard.”

Unfortunately, he said, not all people have an advance directive or living will.

Using her years of experience working with seriously ill and dying patients, Ms MacMillan stressed the importance of having a living will or advance directive. “Advance directives work,” she said.

She explained how easy it is to put one together, and requires no special form or legal help. “The first step is having an open discussion with your family or loved ones,” she said.

She also stressed the importance of choosing the right person to be your proxy when you can no speak for yourself. “Choose someone who will carry out your wishes,” she said.

For more information on living wills or advance directives, go to www.danburyhospital.org.