Law now allows life or death decision in advance

October 01, 1993|By Norris P. West | Norris P. West,Staff Writer

Starting today, everyone in Maryland can make a real life-and-death decision.

A law goes into effect today allowing people to decide whether they should be kept alive by life-support systems or allowed to die if sickness or injury prevents them from making the decision themselves.

"The new law gives people more choices about their future health care than they've ever had before," said Jack Schwartz, the state attorney general's chief of opinions.

He suggests that every adult in Maryland -- not just elderly people -- sign advance directives for health care to outline those future choices.

"The fact is that people over 55, 60 who have had health problems themselves or know others with health problems tend to be the people most interested," Mr. Schwartz said. "Younger people tend to have the mistaken view that they are immortal. Then one night, they could end up in an accident."

Under the measure, passed this year by the General Assembly, people can choose whether to be kept alive on a ventilator or feeding tube in the event they cannot make health care decisions for themselves when they:

* Are in a terminal condition in which death is imminent and there's no reasonable chance of recovery, even if life-support is used.

* Are in a persistent vegetative state, which means they are unconscious and unable to interact with others, and there's no reasonable chance of recovery.

*TAre at the end-stage of a condition caused by injury, disease or illness -- Alzheimer's disease would be one example. In these cases there must be severe and permanent deterioration that has left someone incapacitated and completely dependent on others physically. Treatment of the condition would be medically ineffective "to a reasonable degree of medical certainty."

One person who has planned ahead is Dr. Thomas E. Finucane, an associate professor at the Johns Hopkins University School of Medicine.

Dr. Finucane has signed a document allowing his wife to make health-care decisions for him if he ever is to suffer from any of the three conditions.

"There are many situations I fear that I think would be worse than death," he said, "and my wife understands my goals and my values for being alive."

Dr. Finucane, a geriatrics physician at Johns Hopkins Hospital, said he also appreciates the value of advance directives because they make it easier for doctors to determine what treatment to give patients who cannot express their desires.

Some people in Maryland already have signed living wills and "durable powers of attorney," but both were more limited. People were allowed in those documents to refuse life support only for terminal illness; advance refusal for persistent vegetative state or end-stage condition was not permitted.

Advance directives must be signed by two witnesses, one of whom cannot stand to benefit from the person's death. They do not have to be notarized.

Under the new law, the next-of-kin will make health-care decisions for people who do not have an advance directive.

The attorney general's office is making available a four-page form that Marylanders can use to specify their future health-care choices. State residents also can use the forms to appoint other people to make those decisions for them if they are unable to do so in the future.

The forms can be obtained by calling 576-7000.

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