TIME: Almanac 1993/TIME Almanac 1993.iso/time/120991/1209130.000

Text File | 1992-08-28 | 4.0 KB | 91 lines

                                                                                HEALTH, Page 75

When Patients Call the Shots


The next time you go into a hospital, prepare to be presented
with a living will


    There is nothing therapeutic about the somber process of
checking into a hospital. Already ailing and disoriented,
incoming patients must fill out endless forms, produce insurance
cards and steel themselves for the inevitable probes, cuts,
needle pricks and medications that mark a modern hospital stay.
The last thing patients want to think about is the possibility
that they will never leave -- that their illness or a medical
mistake will leave them comatose and thus incapable of making
life-and-death decisions for themselves.

    Yet that prospect is what most Americans will now be asked
to consider every time they enter a hospital, whether it is to
undergo heart bypass surgery or to get a hernia repaired. A new
law that goes into effect this week requires all federally
funded hospitals, nursing homes and hospices to tell incoming
patients of their right to fill out a living will, a document
that specifies that if something goes wrong, they will not be
kept alive against their wishes. Although the rule is long
overdue, experts wonder whether hospitals are up to the
bureaucratic task and whether jarring questions -- if not
properly handled -- may stir needless fear and anxiety.

    The concept of a living will has been around for decades.
Moved by the tragic stories of comatose patients like Nancy
Cruzan, the Missouri woman who was kept alive for seven years
against her parents' wishes, more than 40 state legislatures
have enacted laws aimed at encouraging patients to make their
treatment preferences known beforehand. Some of the newest laws
authorize people to appoint a surrogate, or proxy, who can make
medical decisions for them when necessary. Widespread use of
such measures could reduce the extraordinary expense of keeping
terminal patients on life-support systems that neither they nor
their family desires.

    Yet so far, just 15% of Americans have made out living
wills, and the new federal rule is an attempt to encourage their
use. At Chicago's Rush-Presbyterian-St. Luke's Medical Center
the admitting clerk reads a little speech to incoming patients:
"Do you have a living will? Can we have a copy of it?" Those who
answer no are handed a pamphlet that goes over the Illinois law
on the topic. A California health-care group has prepared
special booklets describing the basics of living wills in 10
languages, including Chinese and Farsi.

    Unfortunately, the law falls short of ensuring that
patients will get what they want if and when the critical time
comes. Many states allow the withdrawal of treatment or feeding
tubes only under limited conditions, regardless of a patient's
preferences. Removal may be permitted when death is imminent but
not when a patient is suffering from a chronic condition like
"persistent vegetative state." Even now, the decision on what
is best for a particular patient often winds up in court.

    At best, the new law is a mild nudge in the right
direction. "It urges people to get their affairs in order," says
the American Hospital Association's Fredric Entin. Like many
medicines, the measures may at first be hard to swallow, but the
consequences of not taking them could be incalculably worse.


By Andrew Purvis. Reported by Lynn Emmerman/Chicago and Jeanne
McDowell/Los Angeles.

________________________________________________________________
THE TWO BASIC TYPES OF LIVING WILLS


    1. The patient decides whether he wants to prohibit doctors
from performing life-prolonging procedures such as tube feeding
and artificial respiration.

    2. The patient names someone else -- a friend, family member
or doctor -- to make that decision for him. The surrogates can
withhold care, hire and fire doctors, and discharge the patient
from the hospital or nusing home.