Patients to be told of rights Law calls for decisions at admission time.

November 29, 1991|By Patrick Ercolano | Patrick Ercolano,Evening Sun Staff

A new federal law that takes effect Sunday will require most health-care institutions to inform adult patients of their rights to make advance decisions about their medical care should they become mentally incapacitated.

Under the Patient Self-Determination Act, enacted last year, patients would receive the information upon admission to hospitals, nursing institutions, hospices, home-care programs and health-maintenance organizations that receive Medicare or Medicaid funding.

In Maryland, a patient can make an "advance directive" -- a plan for future treatment -- through any or all of the following methods:

*A living will, in which the patient specifies that he does not want life-sustaining medical care if he reaches the final stage of a terminal condition.

*A power of attorney for health care, also known as a durable power of attorney, which allows the patient to name an "agent" -- usually a relative or friend -- to make the patient's health-care decisions if he becomes mentally incompetent.

*A documented discussion with a physician, a written record of the patient's wishes for health care as planned in consultation with his doctor.

Marylanders "have had these rights in the past, but they may not have known about them. The new law will make sure that patients are made aware of their options by their health-care providers," says Beverly Wilson, director of management resources for the Maryland Hospital Association.

"For the first time, people will be sat down and told, 'Here are your rights. You can determine whether you want to be attached to a ventilator or fed intravenously, and so on,' " says Ellen Katz, the executive director of the Maryland Conference of Social Concern, a private non-profit organization that advocates justice for the disenfranchised.

The MCSC will sponsor a conference on the new law next Wednesday from 8:45 a.m. to 4 p.m. at the F. & G. Life Building, 6225 Smith Ave. in Mount Washington. Admission is $35 for the general public, $30 for MCSC members and $20 for senior citizens and full-time students.

About 10 percent of Americans reportedly have made advance directives, Wilson says, but the new law could influence more people to plan their future medical treatment.

As a result, families of patients would be spared the "awful pressure" of making life-or-death decisions, says Katz.

Also, an advance directive would keep such decisions "out of the courtroom," says Sister Cecilia Rose, vice president of St. Agnes Hospital, referring to potential legal battles between families and states over a patient's care.

Critics of the new law say living wills often are too general to guide a medical team. For example, the document may stipulate that a patient not be put on a life-support system, but it may not specify whether food and water also must be withheld.

The American Association of Retired Persons Bulletin recently cited a study in which doctors and nurses contradicted the wishes of 25 percent of 175 nursing home residents with living wills because the documents were not specific enough.

When in doubt, health-care providers tend to err on the side of safety, giving the patient medicine or food that he doesn't want, according to the AARP article.

Another criticism of the law is that it will lead to clashes between patients and doctors over policies that the physicians might not wish to carry out. A patient's living will might include a provision for euthanasia, while his doctor opposes mercy-killing.

"In a case like that, the doctor should make the effort to transfer the patient to another doctor whose policies might be more compatible with the patient's wishes," says Wilson. "If the patient's wishes conflict with the hospital's policy, then there should be some way for hospital officials to intervene and reach some kind of resolution in conjunction with the patient and his family."

Wilson points out that an advance directive can be revoked at any time.

She adds that the directives should be made far in advance. "As our governor likes to say, 'Do it now.' Don't wait until you're checking into a hospital," she says.

The Maryland attorney general's office advises individuals to consult their lawyers and health-care providers about the legal and medical particulars of advance directives.

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