LIVING WILLS MAY PROLIFERATE

THE BALTIMORE SUN

A new federal law requiring hospitals and nursing homes to inform patients of their right to refuse medical treatment under certain circumstances could cause a flood of requests for "living wills," say county health-care providers and attorneys.

Attorneys and doctors heresay they already have noticed increased interest in living wills, which spell out a person's wishes for medical treatment should he or she become terminally ill.

And they expect that the federal law, which will go into effect next November, will only increase the number of people asking for the legally binding document to be drawn up.

Several area health-careadministrators said they think the trend toward obtaining living wills, along with a second document called a medical durable power of attorney, can only facilitate the care of terminally ill patients or those in a permanent coma.

"The hardest thing is dealing with a person who no longer can make decisions and has never told the family what he or she wants," said Lorna J. Rice, director of social work at Carroll County General Hospital. "(The family) ends up sitting in a courtroom, letting a judge decide.

"Hospitals tend to err on the sideof doing too much," she said, adding that an increase in the number of medical malpractice lawsuits has created a climate where medical institutions may be overly cautious. "If we have specific guidelines set up in advance, it makes it a lot easier on everyone."

Rice saidhaving plans spelled out beforehand about the type of medical treatment desired also takes a lot of pressure off spouses or other close relatives, who might otherwise be forced to make the decisions.

Richard C. Murray, a partner with the Westminster law firm Walsh and Fisher, said he has noticed an increase in interest in living wills and the durable power of attorney. About 50 percent of the firm's clientswho come in to have regular wills drawn up request the additional documents as well, he said.

A living will applies in situations where patients are terminally ill, Rice said. Individuals can specify what types of medical treatment they want should they become unable to make decisions about their own medical care.

However, if people want to specify what types of treatment they want should they become permanently unconscious, such as in a coma, they need to establish a durable power of attorney for health care, he said.

This document candesignate someone to make decisions regarding health care, should the signer become disabled. Health care wishes can also be specified inthe document to guide the person given power of attorney in making decisions.

Murray attributed the increased interest in living willsand the durable power of attorney to two factors: the aging of the population and recent publicity about specific cases involving the right to die.

The Missouri case of Nancy Cruzan, who died Dec. 26 after spending eight years in a coma following a car crash, has brought national attention to the issue, he said.

But even with the increased attention surrounding this and other right-to-die cases, said Rose L. Windsor, a vice president at CCGH, a relatively small percentageof patients are entering the 118-bed facility with living wills in place.

"A lot of people know about it," she said, "but it's the kind of thing a lot of people put off doing."

She said she recently attended a seminar for health-care providers on the topic. Of 30 people attending, only one had a living will.

Even people who know all about their rights may be reluctant to get the paperwork done, she said.

She said she hopes that as more people hear about living willsthrough the media and realize the importance of making decisions in advance, they will take the time to write living wills.

"If I don't see an increase over the next couple of years, I'd be very surprised," she said.

The new federal law, which was passed last fall, will require all hospitals, nursing homes, hospices, home health-care services and health-maintenance organizations that receive Medicare or Medicaid payments to inform patients of their legal right to a livingwill and durable power of attorney for health care, said Jack Schwartz, chief counsel for opinions and advice for the attorney general's office.

Schwartz said the legal rights have been acknowledged under Maryland law for several years. What's new is that health-care providers will be required to tell all patients about their rights.

The federal law also spells out when patients must be informed. Hospitals, for example, must make sure all patients are told before they areadmitted.

Richard Wade, vice president of communications for the Maryland Hospital Association, said most of the state's 55 acute-carehospitals already inform patients about living wills and the durablepower of attorney.

Under the new law, however, most hospitals will have to devise more specific procedures for informing patients, he said.

Windsor said Carroll County General already distributes information about living wills to all inpatients and outpatients, but notto emergency room patients unless they are later admitted.

Upon being admitted, all patients are asked if they have living wills or durable power of attorney documents.

With the law mandating that patients be informed, the hospital is working out a strategy to make sure the information is more accessible, she said.

"We'll try to put (the information) in several places, so if they miss it in one place,they'll pick it up somewhere else," she said.

For individuals interested in living wills or designating a durable power of attorney, forms and a pamphlet explaining the process can be obtained by writingthe Attorney General's Office, Opinions and Advice, 200 St. Paul Place, Baltimore, Md. 21202.

Schwartz said the forms are free, and nofee is required to file them with individual doctors or hospitals.

Typically, after people fill out the forms, they should make copiesavailable to their doctors, lawyer, local hospital and family members. Attorneys and health-care providers stressed the importance of telling all appropriate parties about the documents in advance.

"It does no good to fill out the forms and then not let anyone know about it," Schwartz said.

Forms can also be obtained through a lawyer when, for example, a person has a regular will drawn up, said Murray. An attorney typically would charge less than $100 to handle the paper work, he said.

Once a person has filed a living will and durable power of attorney, a hospital is obligated to follow the wishes of theindividual, Schwartz said.

Both documents can be amended at any time and should be reviewed every few years for any desired changes, he said.

Rice cautioned that individuals with living wills who havemoved from another state or who obtained forms from another state should double check with a lawyer or the Attorney General's Office to make sure their documents are binding here.

"You should be careful that it's appropriate in your state," she said. "Living will laws differ from state to state."

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