Now more than 15 years ago, the world watched as Terri Schiavo’s family repeatedly litigated her fate. Regrettably, this highly publicized family conflict could have been easily avoided had Terri prepared an Advanced Medical Directive (“AMD”). An AMD is a written statement explaining an individual’s wishes in the event that the time comes when that person is unable to communicate.
Fifteen years before we were introduced to Terri Schiavo, this Florida homemaker suffered a heart attack at the age of 26 which left her in a “persistent vegetative state” from which she could not survive without extraordinary medical assistance. A person in a “persistent vegetative state” has no reasonable likelihood of recovering. Unable to care for herself, Terri’s husband, despite being Terri’s spouse, had to petition the court to be named as Terri’s Guardian. For only as Court Appointed Guardian would Michael Schiavo then have the authority to make medical and personal decisions for his wife. After many years of watching Terri become emaciated, Michael Schiavo decided that his wife would not have wanted to continue in her current state and ordered that her extraordinary medical assistance (i.e., feeding tube) be stopped. Terri’s parents objected claiming that Terri would not want to die under these circumstances and filed a lawsuit to stop the removal of their daughter’s feeding tube. Without a clear written statement of Terri’s wishes, the court held a hearing and heard the testimony that Terri’s parents offered but eventually ruled in favor of Terri’s husband. The parents appealed the ruling three times to the Florida State Supreme Court and three times to the United States Supreme Court to no avail. At one point in the process, Governor Bush attempted to intervene using his executive powers. The tragedy of Terri Schiavo is that without an AMD her loved ones were pitted against each other, endured a heavy emotional and financial toll, and ultimately may or may not have fulfilled Terri’s wishes.
Although often referred to as a Living Will, an AMD is much more. A Living Will is simply your statement regarding future medical treatment should you be in a persistent vegetative state. The AMD contains the Living Will Statement but goes further. Through your AMD, you appoint a trusted individual to make medical decisions on your behalf, if you are unable to at time of treatment. The health care representative appointed in the directive is given the authority to consult with your doctors and review your medical records which makes an AMD more valuable than a standard Living Will. A Living Will, by its nature, cannot address every possible medical situation. Fortunately, a health care representative can assist in the decision making after considering your wishes and consulting with your doctors. A well drafted AMD will address your feelings regarding such matters as pain relief, nutrition and hydration, extraordinary life sustaining measures and religious restrictions. You may designate one or more health care representatives to act on your behalf. Your representatives may be relatives, friends or any other people you trust to follow your wishes.
With today’s medical advances, doctors are able to prolong life. Through your AMD you can clearly express to your medical provider and loved ones whether you personally favor such prolongation. The AMD allows you to live and die with dignity, as defined by you. It should be emphasized that nothing happens automatically. You will remain on life support until your health care representative authorizes removal. Your health care representative may chose to wait a day, a week, a month, a year or more before deciding to authorize the removal of life support.
As we all know, life is full of uncertainty. We never know when we may require serious medical attention. Terri was only 26 years old when she had her heart attack. Therefore, the AMD is appropriate for young and old alike. The AMD must be signed by a person of sound mind which might not be possible after a sudden accident or illness. Should you prepare an AMD and then change your feelings your AMD may be updated.
Once you complete (and properly execute) your AMD, you should give a copy to your doctor, lawyer, local hospital and the persons named as health care representatives.
When preparing your AMD, you should be absolutely certain that the document expresses your health care treatment wishes. The AMD is a powerful document for maintaining control of your life decisions. By failing to prepare an AMD you lose that control. By preparing a vague AMD you sacrifice all the benefits the document has to offer. Regardless of your beliefs, by preparing a thoughtful AMD now you can provide peace of mind to yourself and your loved ones.