IF THERE'S a lesson from the heart-rending case of Terri Schiavo in Florida, it's the need to get estate documents to tell doctors and loved ones what life-prolonging measures you want if you can't speak for yourself.
Schiavo didn't have these documents 13 years ago when her heart stopped and left her in a vegetative state. Now her husband and parents are battling over what they think she would have wanted.
Recently, Florida's legislature and governor jumped into the debate by overriding a court decision to remove her feeding tube, as her husband wanted. The court challenges are far from over.
"The tragedy ... is that it was totally preventable," said Karen Kaplan, chief executive of Partnership for Caring, an advocacy group for end-of-life care. "The other side of that is that it could happen to any of us at any time."
Up to one-quarter of adults have these estate documents, and most of the people are 65 and older, Kaplan said.
Young adults need them, too, because they can easily become incapacitated, say, in a car accident, experts said. In fact, Schiavo, and two others in high-profiled right-to-die cases, Nancy Cruzan and Karen Ann Quinlan, were all stricken in their 20s.
"To me, it's as important for the 18-year-old as it is for the 80-year-old," said Florida lawyer Jerry Wolf.
Basically, there are two documents you need: a health care power of attorney and a living will. They may be combined in what's sometimes called an advance directive.
A health care power of attorney allows you to name someone to make medical decisions on your behalf if you can't. It's not just life-and-death decisions. The agent can choose your doctor, nursing home or who can visit you, experts said.
The living will allows you to make your wishes known about what medical treatments you want - or don't want - in severe cases, such as if you're in a persistent vegetative state or you're terminally ill with no chance of recovery.
"By being clear in what you want and who you want to make the decisions, you can save your family a great deal of difficult decision-making and stress and self-doubt," said John Eason, a law professor at Tulane University.
State law governs these matters, so the documents often have different names and rules.
New York, for example, requires that only one person be named as a health agent, so a document with multiple agents runs the risk of not being accepted by a hospital, said New York lawyer Ivan Taback.
In Maryland, the signing of an advance directive must be witnessed by two independent individuals, meaning they can't be your doctor or an heir, said Baltimore lawyer Jeff Gonya.
You don't need a lawyer to draw up these documents. You can buy software with the documents, and some states put their forms online, experts said. Hospitals and nursing homes generally offer the documents during admissions. Kaplan's group posts documents from all states on its Web site, www.partnershipforcaring.org.
Still, lawyers usually don't charge much for these documents, so it might be worth the price to make sure your papers comply with state law, experts said.
Also, if you move to another state, make sure you replace old documents, experts added. States are getting better at recognizing documents from other jurisdictions, but it's not worth the risk that your wishes won't be followed because you didn't update your papers, Kaplan said.
Lawyers also recommend that if you split your time between two states, say Maryland and Florida, get documents for both.
Be aware, the documents aren't foolproof.
Sometimes family members don't want to end life support and the doctor goes along, even if it's counter to the patient's wishes, experts said. Gonya said he's encountered doctors who refuse to honor the living will.
That means your care could end up as a court case anyway.
Still, Gonya added, "It's more likely to go to court when they haven't signed one of those documents. If someone hasn't signed one of these documents, and the family wants to terminate life support, you can't do it without a court order. And courts are very reluctant to do that and you end up with a Florida situation."
Give copies of the documents to those who will need them. Some lawyers make several original copies, keeping one for themselves, one for the client's doctor and one for the health care agent.
Don't keep documents in a safe deposit box with only your name on it, where family members and hospitals won't have quick access to papers when needed.
The most important decision you'll make is choosing a health care agent to make medical decisions for you and be your advocate. Make sure your agent knows your wishes and is able to carry them out, experts said.
"You don't want someone who will not be able to comply with your wishes because they are too emotional," Taback said.
Or, you don't want to name someone who has strong religious views against ending life and would be reluctant to stop treatment, if that's what you want, experts said.
Name an alternate agent, too, in case your first choice can't do the job, experts advised.
Let your doctors and family members know your medical wishes, too.
Without these documents or family discussions, you can put those closest to you through a lot of soul-searching, struggle and guilt if you become seriously ill, Kaplan said.
"It's really a gift you give to your family," Kaplan said. "My mother died without any documents. I think I did what she would have wanted but I don't really know. ... I think about it a lot."
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