February 17, 2011

Advance Healthcare Directives: Power of Attorney for Healthcare and Living Wills

In an episode of the sit-com “Seinfeld,” the character of Kramer rents the movie The Other Side of Darkness, a fictional straight-to-video movie that deals with a woman in a coma. Frightened by the movie, he has a living will drawn up. At first, he considers making Jerry his executor, but decides that he is too sentimental after Jerry refuses to throw away his old tennis racquet. Kramer decides Elaine should be his executor instead and they meet with a lawyer After Kramer finishes watching the movie, when the woman miraculously comes out of the coma, he decides he needs to get his living will annulled, but he misses his appointment because he drives so slowly for fear of getting in an accident (‘The Jerk Store”).
The height of the plot is revealed when Kramer talks to Jerry and reveals his own ignorance on the topic. Kramer says, "I finished watching The Other Side of Darkness and the coma woman wakes up. I didn't know it was possible to come out of a coma."
Jerry surprised at Kramer’s ignorance, retorts, "I didn't know it was possible not to know that."
In this episode, the character’s past history as a lovable bumbling fool are played for laughs, but in reality the issues surrounding Kramer’s fears are very real. In our society talking about death can be a touchy and tricky subject, but death and near-death situations are things that will happen to everyone so it is best that we shed our shame and fear and talk about the extinguishing of our candle in a responsible manner. I talk not to coming to terms with your God, but at looking at the necessities we have in this world. A responsible adult will have pre-defined both power of attorney and a living will.

Power of Attorney for Healthcare and Living Wills Defined
Before we delve too much further into the examination of why these tools are important, we should have a look at just what they are. A living will is defined as a written, legal document that spells out the types of medical treatments and life-sustaining measures you do and don't want, such as mechanical breathing (respiration and ventilation), tube feeding or resuscitation. In some states, living wills may be called health care declarations or health care directives (“Living wills and advance directives for medical decisions”). An important thing to notice here is that a living will does not necessitate any procedure be done or not done. The treatments you wish to have done to you as you look at the possible terminal issues are drawn up in advance with a lawyer who specializes in end-of-life care. Drawing up a living will allows you as a future patient to make some of the hard decisions beforehand so that some of the most meaningful decisions you will ever make are not made in a rushed panic. Having a living will allows you to set the terms at which you live.
The situations covered in a Living Will are not exhaustive. Situations may arise when what is covered in the Living Will does not happen and what is happening was completely unforeseen. If this happens, and you are not capable of making a decision, you need someone who will act in your best interests. In this case, going hand-in-hand with the Living Will is the Power of Attorney. The Medical Power of Attorney is defined as “a legal document that designates an individual — referred to as your health care agent or proxy — to make medical decisions for you in the event that you're unable to do so. A medical POA is sometimes called a durable power of attorney for health care. However, it is different from a power of attorney authorizing someone to make financial transactions for you” (“Living wills and advance directives for medical decisions”). Both the Power of Attorney and Living Wills are called advance directives (along with a Do Not Rusticate order). Advance directives ensure that you care will be along the lines of your wishes. You can make sure that no expense is spared, or you can make sure you go gently into that good night. The key is that you give yourself agency beforehand so you live and die as you please.

Advance Directives in the real World
Kramer’s fictional situation may have been played for laughs, but in the real world a lack of advance planning for end-of-life situations can be very tragic. The most notable situation in recent memory where such issues came up was in the case of Terry Schiavo. In the spring of 2005, Ms. Schiavo came to the national attention but her struggle and the struggle between her loved ones persisted for years prior to the media frenzy. “Schiavo suffered severe brain damage in 1990 after her heart stopped because of a chemical imbalance that was believed to have been brought on by an eating disorder. Court-appointed doctors ruled she was in a persistent vegetative state, with no real consciousness or chance of recovery” (Terri Schiavo dies, but battle continues). The struggle over her life was born out between her husband and her parents. Her husband, Michael long maintained that Terry had specifically stated that she would never wish to live in a condition like the one she had deteriorated to. Her parents fought Michael at each step of the process, involving the state supreme court and even in the end the United States Congress before it went to the federal courts. A judge eventually sided with the husband – her feeding tube was removed – and she was allowed to pass on as the Supreme Court declined to hear the case.

The Schiavo case became a circus. The media engulfed the small town the hospice was located in, it made the dedicated workers feel like prisoners as media and various hangers-on of wide-ranging interests made the Schiavo bed a proxy for so many other issues raging in the ongoing culture wars. The Schiavo case was a circus that did not have to be. The only reason it was a circus was because of the lack of legal documentation prior to the 1990 incident that endangered Ms. Schiavo’s health. Had she planned ahead, like Kramer, then the ensuing circus would never have taken place. The acrimony between the two warring parties would have been avoided because the true intent of the patient would have been known and the person she would have wanted to speak for her would be allowed to speak. Unfortunately, episodes like this need to happen in our society before people are willing to talk about such a sensitive topic. A 2006 study, taken a year after the Schiavo case brought the need for advance directives into the public consciousness, showed that only about a quarter of adults in the United States had living wills (“A year after Schiavo's death, 'living will' quandary remains”). A quarter is far too low a rate for a country that will not talk about death. Please, make sure you have your advance directives in place now and not later. Later may be too late. Do not do it for your loved ones. Do it for yourself.

Works Cited

Mayoclinic.com. “Living wills and advance directives for medical decisions” http://www.mayoclinic.com/health/living-wills/HA00014 Accessed February 2, 2011.
MSNBC. “Terri Schiavo dies, but battle continues” http://www.msnbc.msn.com/id/7293186/.Accessed February 2, 2011.
USAToday. “A year after Schiavo's death, 'living will' quandary remains” http://www.usatoday.com/news/health/yourhealth/2006-04-02-your-health_x.htm. Accessed February 2, 2011
Wikipedia, “Jerkstore” http://en.wikipedia.org/wiki/Jerkstore Accessed February 2, 2011.
Youtube. “Seinfeld The Comeback: Coma” http://www.youtube.com/watch?v=c0snC9_E_no Accessed February 2, 2011.