Betty C. Cole's daughter didn't ask for a new stereo or a red convertible when she turned 18. Instead, she wanted two legal papers guaranteeing her right to die.
The gift seemed a little strange for a healthy college freshman. But Cole, an Annapolis attorney who specializes in estate and trust law, understood her daughter's unusual wish.
It was prompted by the plight of Nancy Beth Cruzan, the Missouri woman who has spent nearly a decade lying in a coma after a car crash almost claimed her life.
Cruzan's parents gained national attention by fighting a drawn-out legal battle to remove her life-support system.
The U.S. Supreme Court ruled against them last June, saying privacy rights guaranteed by the Constitution don't cover a family's request to end life-sustaining treatment. But the Cruzan family plans to stage another appeal based on new testimony from friends who contend Nancy would have wanted to die naturally.
Cole cited the Cruzan case as the most compelling reason to own a living will and a durable power of attorney. Both documents provide "clear and convincing evidence" needed for physicians to stop life support, she told about 30 senior citizens and nurses during a workshop Tuesday at the Anne Arundel Medical Center.
Her speech was the third in a series of events this week sponsored by the Annapolis hospital to raise awareness about critical care -- medical treatment for a life-threatening illness or injury.
"Most of the time when people experience critical care, it's during a crisis," said Myra D. Landmesser, a clinical nurse specialist who arranged the series. "They come in when their parents just had a heart attack or after a car accident, and they're completely unfamiliar with all the technology. It's very scary. This gives people a chance to talk about it beforehand."
Cole, a Severna Park resident who lobbied for Maryland's living will statute in 1985, said proper documentation is the only way to avoid being kept indefinitely on artificial life-support systems.
"If you're terminally ill and dying, or if you're in a car accident like Nancy Cruzan, (physicians) can't withhold treatment unless you have executed a power or attorney or a living will," she said. "I think both are very important, because I believe it's your right to decide about your health care."
Since the living will only covers "an incurable injury, disease or illness certified to be a terminal condition by two physicians," Cole encouraged the audience to also seek a durable power of attorney.
Near-fatal car or diving accidents sometimes leave a patient lingering in a coma that's irreversible, but not necessarily terminal, for years, she said.
The power of attorney designates another person to make financial or health-care decisions in a debilitating emergency.
Attorneys often have been reluctant to discuss right-to-die laws in the past, Cole admitted. She said she decided to break with the trend five years ago after becoming "increasingly concerned about the rights of dying patients."
Cole recently published an article in The Daily Record, a Baltimore legal paper, arguing that the living will alone does not automatically "prevent unwanted artificial prolongation of dying." In the piece, she argued that the living will does not offer help for those who have lost all awareness of themselves and the surrounding environment.
She also criticized the provision calling for physicians to continue providing comatose or terminally ill patients with food and water.
"A lot of people don't want tubes introduced if they're dying," she said. "There isn't a lot of connection between Thanksgiving dinners and feeding."
She ended her talk by urging audience members to arm themselves with legal documents to protect against the chance of ending up with a borderline life, kept going only by artificial feeding and life-support systems.