Don't make end-of-life decisions harder

February 21, 1994

Only a year ago, the General Assembly enacted a comprehensive Health Care Decisions Act governing the ways in which Marylanders can register their preferences about life-prolonging medical treatment. The law went into effect Oct. 1, less than five months ago, but already there is a bill in the state Senate that would reverse the thrust of that policy by imposing restrictions on advance directives. Sponsored by Sen. John A. Cade, R-Anne Arundel, the bill will receive a hearing this week in the Senate Judicial Proceedings Committee. It should go no further.

The Health Care Decisions Act was the product of extensive discussion among representatives of the medical, legal and religious communities, hospitals, nursing homes and legislators. Although living wills and other forms of advance directives have been around for two decades, only about 20 percent of Americans actually have taken advantage of them.

That gap can leave family members and physicians in a bind if an emergency arises and a person is incapable of expressing his wishes about heroic medical treatment. Thus, a major goal of the legislation was to encourage more Marylanders to make advance decisions by simplifying the procedures.

Senator Cade's amendments would hit older people particularly hard. One provision requires that any person in a nursing home who wishes to make an advance directive can do so only in the presence of an ombudsman from the state Office on Aging. Since there are only one or two ombudsmen in each county, it could take several days to get one to the nursing home; by that time, it may be too late. As yet, we know of no evidence of abuse of the current law, which requires two witnesses, including at least one with no financial interest in the person's estate.

Another provision in the bill would make it more difficult to make advance directives orally, hampering people who are intimidated forms and legalistic language. Yet another would severely tighten provisions that allow a person to change his mind and revoke an advance directive. That's scary.

Senator Cade apparently worries that the policies embraced last year allow too much room for abuse. But surely it would be better to give the new law time to work before abruptly reversing course and imposing tough restrictions on vital end-of-life decisions.

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