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Living Wills, Medical Directives Discussed At Forum

Westerly -- She was mentioned by name just once, but Terry Schiavo -- the brain-damaged Florida woman who died last month after a lengthy and public family dispute over whether her feeding tube should be removed -- was the reason Connecticut and Rhode Island residents packed The Westerly Hospital's Henry J. Nardone Conference Center Tuesday.

As part of its regular Community Education Series, the hospital hosted a free panel discussion on living wills and advance medical directives.

The panel featured participants with backgrounds in medicine, medical ethics and the law who shared stories of crises that arose when people failed to make known their wishes on end-of-life decisions, and advice on preventing similar situations.

The time for family members to begin discussing end-of-life wishes is not when one among them is brought to a hospital's intensive care unit in critical condition, said Dr. Walter J. Lenz, a Westerly primary care physician certified in internal medicine and geriatrics.

"This is a perfect storm for the doctor as well as a patient and family," he said.

The doctor has other patients to care for. Family members may not be on the same page as the patient or each other, if they are speaking to each other at all.

Factor in guilt and money, Lenz said, and the situation can become a crisis.

Lenz and his fellow panelists urged listeners to consider outlining their wishes in a living will or durable power of attorney for health care. In simple terms, a living will outlines the conditions under which a person wants his or her life support to be removed, said Rhode Island Superior Court Justice Jeffrey A. Lanphear.

A durable power of attorney for health care empowers another person to act for a patient who cannot communicate on whether and when to terminate life support; which treatment to choose; and other medical decisions, Lanphear said.

But even those documents, which the panelists said can be drafted cheaply by a lawyer or without a lawyer at all, can be complicated.

"How do you want it to be like at the end of your life? This is not an easy question," said Dr. Thomas A. Bledsoe, associate professor of medicine at Brown University and director of the university's Center for Biomedical Ethics.

Patients meet serious illness with three strategies, Bledsoe said: win, fight or accept.

They can attack their illness with all available means, use reasonable but not all-out methods to treat illness, or simply accept illness without treating it at all.

In addition to choosing their strategy, patients also need to think about who they want in charge of their fate if they can't communicate, and how they want that person to proceed.

These wishes, the panelists said, should not only be included in a living will or power of attorney for health care but should be discussed with family members, even and especially when everyone is gathered together on occasions like Thanksgiving.

"If I can stress anything to you ... it's the importance of communicating with your doctors, your family members - and don't hide away those advance medical directives," said Rhode Island attorney Jay Elias, a lawyer for The Westerly Hospital.

Rhode Island and Connecticut have very similar end-of-life laws and documents, said the panelists. They are available online in English and Spanish at each state's Department of Health Web site.

The panelists offered these tips for those considering their end-of-life wishes:

- Either outline your wishes in a living will or have someone else empowered by a durable power of attorney in charge of your health care decisions when you can't communicate. Having both documents confuses doctors and lawyers about who is in charge.

- Give copies of your living will to several family members, and try to make sure one is brought to the hospital if you are taken there for treatment. Try to keep one on your person at all times - the text can be shrunk to fit easily in a wallet or purse.

- Technology changes. No one wants to be put on an iron lung, but respirators are an improvement. Use broad language in your living will to outline your wishes so they'll remain a true reflection of your plan.

- If possible, have a lawyer draft your living will or durable power of attorney. The document won't be tested until a critical time and will save families from additional pain if done correctly.

Tuesday's event drew so much interest the hospital had to turn some people away and will organize a similar program to be held sometime in the next six months, said spokesman David Tranchida

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