The Alpha Delaware Living Will Kit

By Kermit Burton, Alpha Publications

Venue:

Delaware.

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Description:

One of the more notable modern day medical achievements is the ability of medical practitioners to employ a variety of available medical procedures to keep medically alive an individual who may otherwise be considered brain dead.

In a broader, rather than a narrow description of these medical procedures, it is generally perceived that life support procedures include any or all of the following procedures, namely: cardiopulmonary resuscitation, mechanical respiration, artificial feeding, kidney dialysis, chemotherapy, transfusions of blood or blood components, antibiotics, pain medications, etc.

It can however be noted that most of these procedures can appropriately be classified as lifesaving rather than life supporting in the sense that life can be continued or restored when any one or more of these medical procedures are employed.

But, the real concern is whether or not the use of any of these procedures is professionally ethical when an individual is in a permanent or persistent vegetative state which has been deemed irreversible.

The problem lies not in the ability of medical practitioners to keep an otherwise brain dead individual alive, but in their ability to correctly diagnose the vegetative state of an individual.

In other words, medical technology has not achieved a fool proof standard that can unequivocally diagnose whether or not an individual is permanently unconscious.

This then is precisely why the Right-to-Die Laws differ among the various states. For example, some of the State Law Makers were not convinced that the decision to terminate any Life Support Systems should be left to other than the discretion of the medical practitioners or hospital staff.

Fortunately, many others were convinced that the decision to terminate Life Support Systems could be entrusted to the affected individual in the form of an Advance Directive which commonly became known as the Living Will Declaration.

Many of these law makers were besieged with countless stories of families who had experienced a severe financial crisis when a medical institution continued to employ expensive Life Support Procedures over the objections of the patients' family and, in many cases, the attending doctor.

In 1990, one of the widely publicized cases in this area was the Nancy Cruzon Case, which originated in the State of Kansas and went before the United States Supreme Court. The Supreme Court, while not granting the relief sought on behalf of Nancy Cruzon to terminate the life support systems, did recognize the right of an individual to make a Living Will Declaration or other similar document that authorizes the termination of life support systems.

Since Nancy Cruzon did not have a written document expressing her desire not to be kept alive with artificial life support systems, the Supreme Court did not order the termination of the life support systems.

The United States Supreme Court also gave the States wide latitude in prescribing the legal provisions and requirements for making a Living Will Declaration or similar document.

In 1991, the United States Congress enacted a law called The Patients Self-Determination Act. The law effectively requires that any hospital, nursing home or other health care facility participating in the Medicare and Medicaid Program must inform all adult patients of their right to make a living will under State Laws.

While the Living Will Declaration purports to be a declaration by the maker to terminate life support procedures, in some cases however, it also addresses what life support procedures can be continued, plus, if State Laws so provides, it allows for the termination or continuation of intravenous feeding.

In other words, those States that do prohibit the termination of food and fluids have concluded that even when considering the vegetative state of an individual, it would not be appropriate to starve the person to death by withholding food and fluids.

This issue gained national prominence in 1992 when a woman in a New York hospital unexpectedly awoke from an extended coma in an otherwise healthy condition. However, considering the extended period of the coma, had food and fluids been terminated, it is highly unlikely she would have awoken since she would have no doubt starved to death.

The point being made here is that serious consideration should be given to any decision that allows the withdrawal of food and fluids, not withstanding such rights under State Laws.

Also, it was recognized by many State Law Makers that the terminal condition of an individual was not the only consideration, but also consideration of the non-terminal unconscious condition of a person. Therefore, it was this consideration which resulted in the enactment of Health Care Appointment Laws that provides a person the right to appoint another to act on his or her behalf in the making of medical treatment decisions when such person is unable to do so himself or herself.