Living wills get surge of interest: Lawyers, caregivers, estate planners field more questions about advance directives in wake of Schiavo case

July 11, 2005

When Mick Meiners brings up living wills these days, his clients tend to pay more attention than they did before the Terri Schiavo case dominated headlines.

"In the past, people would say, 'Yeah, that might be something I might get to or it's something my parents should do,'" said Meiners, a certified financial planner with Financial Plans & Strategies Inc. of Indianapolis.

The St. Vincent Hospice also has seen a spike in interest, with more phone calls from people asking for information about advance directives such as living wills, according to Debra Bosler, the hospice's outreach liaison.

"We've mailed out a lot of information, and even our own staff and volunteers have had questions and pursued that because of the Schiavo case," she said.

Statistics that track the popularity of living wills are hard to find. But health care providers, lawyers and estate planners all say they've seen interest in this element of estate planning rise thanks to Schiavo, the brain-damaged Florida woman who died in March at age 41 after being removed from her feeding tube.

Schiavo spent 15 years in what several doctors called a persistent vegetative state while her husband and family quarreled over her future. She had no living will.

Will interest last?

Whether the increased interest in living wills sticks around depends on whom you ask. But people involved in all sides of the issue say those documents-and the appointment of a health care proxy to make decisions for you-are vital to avoiding a repeat of that situation in Indiana.

Indiana's living will form states that a person wishes that life-prolonging procedures not be used in certain circumstances, according to Jeffrey Dible, a partner in the law firm of Locke Reynolds LLP who focuses on estate planning.

The other form of the living will law is the life-prolonging procedures declaration, which requests medical treatments to extend life.

Living wills should be combined with a health care power of attorney because they do not carry a lot of legal weight otherwise. Part of that comes from ambiguous language found in the living will, according to Stan Jones, coordinator for pastoral services at Methodist Hospital.

The living will has no power until a physician documents that a person has a terminal illness and his or her death is imminent. Jones noted that the legal lingo does not define "terminal" and "imminent."

"Families, patients and physicians all have to define that themselves," he said. "Therefore, it leaves a lot of ambiguity."

Living wills alone cannot solve a dispute between family members about whether a patient's feeding tube should be removed. Appointing someone the power of attorney for health care helps. That also means the hospital or doctor works with one patient representative instead of four or five, Dible noted.

Appointing a health care power of attorney "really allows someone to stand in your shoes and make specific decisions," Meiners said.

Meiners once had a client with a living will who languished in a vegetative state on life support because his nursing home refused to remove the support. The man's health care power of attorney eventually moved him to a different home, one that respected his wishes.

"This is an individual who would have been enraged if he had known he would have been lying there for weeks and months," Meiners said.

Disagreements about a patient's wishes probably develop once or twice a day at Methodist, Jones said, noting that the hospital handles some of the worst emergency room cases.

"These are difficult decisions for families to make when it gets down to it," Jones said. "The emotional burden of all this is just terrible."

Aside from protecting a patient's wishes and stopping family disputes before they start, a living will and health care power of attorney also provide a measure of relief for doctors and other care providers.

"We are able to do what the patient wanted," Jones said. "It's a protection of the patient's autonomy and a patient's right to decide how they want to be treated when it does come to a place where there's no hope for recovery."

Without this help, medical professionals and family members are forced to "muddle through what really is the best thing when there is no indication from the patient," Jones noted.

People normally draw up living wills as part of an estate-planning package, said Mark Pfeiffer, a partner with the Indianapolis law firm Harrison & Moberly LLP. Those packages normally run $500 to $1,000, but the living will portion can cost as little as $100, depending on what someone wants and how long it takes the lawyer to put it together.

High-profile cases make impact

Interest in health care directives always peaks whenever a right-to-die case gains publicity, whether it involves Terri Schiavo, Karen Ann Quinlan or Sue Ann Lawrance. It comes to people's attention, "then we kind of get lulled into the sense of, 'It's not going to happen to me,'" Bosler said.

"But it's certainly something everyone should have," she said. "It could happen to anybody at any time. I think with [Schiavo] being young and it just coming out of nowhere, that is a wake-up call for everybody."

Meiners noted that people as young as his teen-age daughter followed the case, which carried a lot of emotional impact.

Dible said the Schiavo case made people uncomfortable; it received national media attention and involved the U.S. Congress and the Supreme Court. Still, it's tough to predict how long any increased awareness will last.

"My gut feeling is because the Schiavo case was so prominent and because it went on for so long, I think it's going to be a while before people forget about the kinds of terrible things that can happen when an individual does not put his or her wishes down in writing," he said.
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