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Planning to the Last Detail: Here's How

By January W. Payne
Washington Post Staff Writer
Tuesday, April 5, 2005; Page HE01

Nancy Crawford already has a living will, which describes the type of medical care she would want if she were too ill to speak for herself. But the intense news coverage about Terri Schiavo, the severely brain-damaged woman who died last week amid controversy about her wishes for medical treatment, have made Crawford and many others rethink what their written medical instructions should include.

Crawford plans to replace her living will with a more comprehensive document called "Five Wishes," which is distributed by the nonprofit Aging With Dignity. Her employer, Elkton, Md.-based Chesapeake Publishing Corp., has ordered copies of the document for all 500 of its employees.

The Bar Association and the Maryland AG's office weigh in: One raises questions, the other aims to answer.

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Five Wishes allows people to explicitly state their preferences for medical care and asks them to name someone to make their health care decisions if they are unable to do so themselves. It also permits users to state preferences about death at home, organ donation and funeral arrangements.

The Five Wishes directive -- one of many such documents that can be ordered online or over the phone -- reflects a trend of putting previously distinct legal documents in an all-in-one format, said Charles P. Sabatino, assistant director of the American Bar Association's Commission on Law and Aging. Living wills and health care powers of attorney (also called agents or proxies) were often written as separate documents. (See "End of Life Glossary" on Page F4 for more detailed definitions of these terms.)

Nonprofit groups inundated with calls and e-mails about such documents over the weeks preceding Schiavo's death say that many people don't understand the various legal terms. Many people did not know they could go much further in specifying their end-of-life wishes than a standard living will typically does.

But there is no shortage of options for advance medical planning. A Google search of the term "living will" last week returned 1,020,000 hits -- many containing forms meant to be used for advance medical planning and some charging a substantial fee. The term "advance directive" returned 127,000 hits.

With the decision to create an advance directive comes concerns about legal issues, particularly for those who travel frequently. But Sabatino said that those who live in the Washington region, where residents may travel daily among three jurisdictions -- Maryland, the District and Virginia -- don't have much reason to worry: The legal requirements "are fairly similar in all three [local] jurisdictions," he said, "so you should be able to get away with one advance directive."

There are some local variations in witnessing requirements, said Sabatino. But Five Wishes, which is legally valid in 36 states and the District, will work in all three jurisdictions.

People should remember to review their advance directives frequently because priorities and preferences often change over time, experts said.

Equally important as creating an advance directive is discussing your wishes with your health care proxy and other family members and close friends, said Paul Malley, president of Aging With Dignity, which is based in Florida. Doing so may help prevent conflict when a decision to stop or continue medical care must be made.

People designated as a health care proxy or next of kin are often asked if they want health care providers to follow written instructions left by a patient, and a conversation between the patient and his designee well before this happens can help ensure that the patient's wishes will be honored, he said.

Following is a list of resources for advance medical planning. Some provide instruction and advice; many include fill-in-the-blank forms that, when witnessed or notarized (depending on state requirements), become binding legal documents.

Five Wishes. More than 20,000 people have requested at least 150,000 copies of Five Wishes -- for themselves, friends, family members and employees -- over the last few weeks, group officials report. The document costs $5 each and can be ordered in bulk (25 copies or more are $1 each) at www.agingwithdignity.org or 888-5-WISHES.

MyHealthDirective.com. Five Wishes documents purchased through MyHealthDirective (for $5 each) get a free year of secure online storage and are accessible with a user name and password. The cost after the first year is $2 annually. The site will store and post other types of advance directives for $2 per year.

National Hospice & Palliative Care Organization. This nonprofit group's Web site offers free state-specific advance directives and also includes advice for communicating your wishes to family and close friends. At www.nhpco.org (click on "hospice and palliative care information") or 800-658-8898.

Maryland Office of the Attorney General's guide to creating advance directives. Includes free advice, instruction and forms for Maryland residents. At www.oag.state.md.us (look for link to "advance directives and living wills") or call 410-576-7000.

American Bar Association Consumer's Tool Kit for Health Care Advance Planning. Helps with "discovering, clarifying, and communicating what is important to you in the face of serious illness," says the Web site. Includes free worksheets, resources and suggestions, but does not create the directive for you. At www.abanet.org/aging/toolkit.

ABA Common Legal Myths About Advance Medical Directives. Written by the group's Charles P. Sabatino, the list puts to rest 10 myths about advance directives, such as "an advance directive means don't treat" and "I need a lawyer to do an advance directive." At www.abanet.org/aging/myths.html.

Mayo Clinic's advance directive resource. This article provides an in-depth description of advance directives and how to create one. At www.mayoclinic.com(look for link to advance medical directives or put that term in the search engine). •

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