Rob Falk

  The case of Terri Schiavo was tragedy from all perspectives.  It pitted family member against family member in a fight over what her final wishes would have been.  Because Ms. Schiavo did not put her wishes in writing, she became the focal point of one of the ugliest court battles in American history.

Every state recognizes advance directives, which allow patients to state how they want their end-of-life care to be handled.  Physicians should routinely ask patients if they have an advance directive.  Make it part of your intake process.  Put the advance directive in the patient's chart.  Take the time to go over the advance directive with the patient.  If they do not have an advance directive, encourage them to execute one.  The National Hospice and Palliative Care Organization (www.nhpco.org) has model forms for every state available on their website.  And if you, as a physician, don't have an advance directive for yourself, take the time now to get one. 

Remember, we are all one accident away from not being able to make decisions for ourselves.  Let's make sure our families and our health care providers know what we want.  No more Terri Schiavos.

Advance Directives and Physicians (Nancy Collins, Thu, May 26, 2005) The confusion and heartache surrounding the Schiavo case could have been averted had the Florida woman completed an advance directive for healthcare. The case points to the need for directives for young adults as well as the aged population. Most patients have given the subject some thought (and after the Schiavo case many discussions took place among family members at dinner tables -- "Mom, what would you want the family to do in a situation like that one?") but many patients may need help from their physicians in making their decisions more precise. What role can physicians play? According to Arthur R. Derse, MD, President of the American Society of Bioethics and Humanties, "For physicians, the best way to broach the subject is to say, 'I talk about this with all my patients.'" Physicians should start the discussion with every adult patient and not wait until an illness to trigger the conversation. Another suggestion is to print on the new patient questionnaire, "Do you have a living will? If not, would you like one?" As a public service to all Web visitors, Kaiser Permanente offers free information on living wills and medical powers of attorney at www.kp.org. The site offers a full range of related topics including a checklist of issues to consider, the type of health care and medical procedures a patient might want, the four steps in preparing an advance directive and information on how to become an organ donor. Other useful sites include the AMA advance directives resource page at www.ama-assn.org/ama/pub/category/14894.html and Center for Practical Biotethics produces a "Caring Conversations" advance directive program and guidance at www.midbio.org.