Tuesday, March 22, 2005

Advance Directives

The case of Terri Schiavo is a vivid and painful reminder for all of us to get our healthcare directives in order. There are forms for this purpose freely available (such as this one for California), though be aware that law may vary from state to state. More importantly, you need to talk about it with your doctor, your family and close friends, so that you understand the issues, and so that your intentions are well known. (Here's some good general advice from the California Attorney General.) Make sure you try to think about various eventualities. Some of the terminology in some forms can be confusing or unclear. For instance, sometimes a form may say "I do not wish to have any heroic measures to prolong my life." But does that mean you don't want to be resuscitated the moment your heart might stop, even if there is a fair chance of revival? Or does that refer only to sustained chronic treatment after some length of time (and what may be a reasonable length of time)? What about potential trade-offs between pain management at the risk of accelerating death? It can be squeamish stuff, but it's important to talk about it.

You may hire a lawyer to prepare your directive, but it is not necessary. In California, the law governing advance health care directives is fairly straightforward. You can find it in California Probate Code sec 4670-78. The only legal requirements for such a document are that it is dated, signed by the patient, and either notarized or signed by two witnesses who meet certain requirements. (Witnesses should be personally known to you, but not related to you, not someone who would inherit from you, not your "agent" for making your decisions, and not anyone associated with providing your health care.)

Even if you have a healthcare directive, it's important to periodically review it. As health technology advances, there may be new eventualities you hadn't considered before, or would consider differently. On a semi-lighter note, David Velleman of Left2Right has anticipated one new eventuality. He has published an advance directive stating that in the event of irreversible brain damage, he is refusing in advance to respond to any Congressional subpoenas.

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