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About Oregon daily emerald. (Eugene, Or.) 1920-2012 | View Entire Issue (June 3, 1987)
OREGON DIRECTIVE TO PHYSICIANS Directive made this make known my desi below and do procedui final from such 3. lu make this direc mind, wilfully and voluntarily under the circumstances set forth Iness certified to be a terminal where the application of life of my death and where my procedures are utilized. I to die naturally. such life-sustaining and phystcianis) as the ' the consequences tally competent to I hereby witness this direc (1)1 personally To the best of m (a) Am not re (b) Do not havi (c) Am not cntitl operation of (d) Am not a physi attending the Declarant is a I understand that if I have responsible for any Courtesy ot Oregon Health Decisions LivingWiils By Wendy Fisher Of lb* hmerald Eighty-two percent of adults in Oregon have heard of living wills; 16 percent actually have them. The few who have living wills believe that to prolong their life artificially, to depend on family and machines to maintain their life, is to throw away any dignity they have left. A living will is a written document stating that a pa tient maintained by “extraordinary" means such as life sustaining systems, antibiotics or surgery used only to pro long their life may refuse treatment. Fear of death or fear of possible pain from removal of life-sustaining systems lead others to waive the pursuit of a living will Others believe they may recover from a coma and having a living will may endanger that chance. "There are many stories of comatose patients coming out of a coma despite their doctor’s opinion." according to Robert Wheeler, a Eugene attorney who specializes in living wills. Some believe a possible cure may be found while they linger in a coma, he said. There are three main types of living wills, each offering a variety of options. One is specifically for terminal pa tients. while others may be used by patients even if death is not imminent. In all cases, the patient must have "extraor dinary" measures before the living will can lie enacted. What exactly constitutes "extraordinary" measures is where the controversy surrounding the issue arises. Of the three main types of living wills only one, the Directive to Physicians, has passed through Oregon state legislative channels. The directive states that if you are cer tified "terminally ill" by two physicians, you may refuse antibiotics, surgery or life-sustaining systems used only to prolong life. The directive must be signed by two competent adults not related to or having any claim to the patient’s estate. The second type of living will is not legally recognized by the Oregon legislature, but it is upheld as legal by Oregon courts. The Living Will is not considered as "strict" or "limiting” as the directive and hence is much more controversial. Depending on which version of the Living Will a per son selects, there is usually a choice of four or more options. In the face of impending death, a patient may refuse elec trical and mechanical resuscitation or nasogastric (through the nose) feeding tubes and mechanical respiration. A pa tient also can choose where to live during the last days of a his or her illness and whether to donate organs The patient who signs a Living Will also may choose to sign a Durable Power of Attorney; a person is thereby ap pointed by the patient to make treatment decisions for them should they become incapable of communicating. lastly, a fill-in-the blank option allows the patient to select specific provisions he or she wants. One example might be deciding whether to be transported to a hospital if a patient's condition worsens causing an emergency, or to refuse life-saving surgery. The Living Will then should be signed and dated by two witnesses over age 18. The last type of living will is tho Power of Attorney for Health Care. As with the Living Will's power of attorney, this document allows a patient to appoint a person to make treatment decisions based on advisory discussions with medical professionals, lawyers or a previously appointed person. Unlike the Living Will, this does not require the authorization of the patient's signature by a notary public. The Power of Attorney for Health Care, however, must be signed by two qualified witnesses. The power of attorney document states that if you are terminally ill or in a persistent vegetative state and are com atose or unable to make decisions, the person designated by the [lower of attorney will make all treatment decisions. The document also offers options to choose from such as whether to withdraw electrical and mechanical resuscita tion. mechanical respirator, nasogastric, gastrostromy (through stomach wall) or intravenous feeding and an tibiotics to treat life-threatening infections. The directive is the least controversial and simplest of the three types of wills. One apparent benefit of the directive is that it does not prolong life with a respirator. If pneumonia or other il lnesses develop, there is the choice of whether to treat with antibiotics or surgery. Dr. Gary Glasser, a specialist in diseases of the elderly, and Wheeler both believe the directive is helpful. “It is useful in terms of setting up guidelines.” Glasser said. The directive also stimulates communication within the family, according to Wheeler. “It helps to get people talking about it, especially with the right people, such as doctors and family.“ he said. It is the only legally binding document. Wheeler said. Because of this, the physician is required to do as the pa tient wishes or transfer him to a doctor or hospital that will. Physicians also are protected by law from having any criminal or civil actions filed against them. But Wheeler said the directive is too limited. “It only covers the very end of life, whereas the Living Will and Power of Attorney turn help earlier," he said. Since the directive allows only the removal of the respirator, patients who continue to breath on their own after removal of the respirator may linger on the edge of death until they die of natural causes, he said The Oregon legislature is currently considering five proposed laws to change the directive. One proposal would allow the removal of a feeding tube, giving patients who linger a choice to die sooner. Some say the Living Will itself cannot be consciously separated into good and bad points because it benefits those in a vegetative state. The Living Will does not require the holder to lx* terminally ill and allows removal of the nasogastric feeding tube. In the United States alone, 10.000 patients are con sidered to be in persistent vegetative states A vegetative state implies conditions ranging from slightly brain damag ed to very brain damaged In all cases, the patient is unresponsive to stimuli. “Most people think, of vegetative state as permanent.” said Brian Churchill, a registered nurse and organ donor coordinator at Sacred Heart (General Hospital. "This is not necessarily true." In fact, some vegetative states are eventually reversible; still, many continue to linger in zombie-like states. The directive is no help to them because they are not considered terminal. Many are cases such as Karen Ann Quinlan, a young woman who lingered for 10 years in a persistent vegetative state after removal of a respirator failed to end her life The Living Will and Power of Attorney may help patients like Quinlan die sooner by allowing removal of feeding tubes The issue is controversial. Starvation is a slow and agonizing process, and it is not known whether comatose or vegetative patients have a sense of pain. In many cases involving terminally ill patients, the removal of feeding tubes may actually aid in comfort. Glasser said. Right to Life, which is concerned with the “sanctity of human life." is :)avidly against the Living Will, especially removal of feeding tulies Members of this group believe it may lie opening doors to suicide and mercy killing. "We are headed toward the handicapped having their food and water withheld," said Cayle Atteberry, the chair woman for Eugene Springfield Right to Life. The Living Will also could lie abused by dialysis pa tients and others with active minds who must depend on machines to keep them alive, Atteberry said If allowed to sign the Living Will and the physician complies, the patient may "commit suicide” by having feeding tulies or other life-sustaining systems removed, she said "We have gotten ourselves into this with our advanced technology." Attelierry said. "We're opening a huge door We've got to stop, got to draw the line." An act of compassion may lead to mercy killing to slop the agony a patient goes through as they starve to death after removal of feeding tubes, she added, Attelierry used abortion to illustrate her point. "People felt sorry for rape and incest cases, which am less than 1 percent (of abortion cases), and now we have I ri million babies killed. 99 percent simply because of inconvenience — we opened the door,” she said. The Power of Attorney has generally the same points as the Living Will because it allows removal of feeding tubes from non-terminal patients. Wheeler sees the Power of Attorney as one of the most useful documents because treatment already lias been discussed and options marked on the form. Wheeler believes this allows less chance fur misinterpretation In addition, a Power of Attorney can Ire used to take ac tion against a negligent person if the patient's illness was caused by an accident or carelessness. ()f the five proposed changes to the directive the Oregon Legislature will decide on. Atteberry (relieves not all will pass because of outspoken controversies (’hanging the minimum age of signing a directive from tH to 15 meets arguments not only from Right to Life, but from others w'ho believe t5-yeur-olds are not mature enough to make such large decisions. Another proposed law is to give oral and non-verbal directives the same legal impact as a written directive. Controversies confronting this are Ihe possibility of misinterpretation, especially non-verbal. Classer believes it may have an advantage because written words don’t change, hut patients’ thoughts change as they experience life on machines. Requirements of witnesses signing directives may be relaxed Currently, a witness must not !*• related to the pa tient by blood, have any claim on the holder’s estate or be providing health care to the patient These limitations would be eliminated. If the proposal passes, it could in crease the likelihood of forgery not only for deviant pur poses but for emotional and compassionate purposes. However, "when doctors an* making decisions they always consider a hidden motive a relative may have,” Classer said. Obtaining a living will can still tie done easily, accor ding to Wheeler, ami a lawyer is not necessarily needed if the Living Will is reati carefully and signers consult with their family. "Any stationery store carrying legal documents carries a directive for about 25 cents." he said. The forms must he filled out corrocty, though, or the directive may la* void, he warned. A Power of Attorney and directive along with a latoklel explaining living wills can bn found at the Western Oregon Health Policy Institute of Kugeoe. OH W. 10th Ave . Room 337. Wheeler said. The Living Will itself can la* received from Concern for Dying. 250 W 57th St.. Room 831. New York. N.Y., 10107. “If (a patient) hasn't made their desires known, there is no sense of what is right." Classer said. "People come down to operating on their own sense of values." Classer said lie hus seen families suffer the trauma of decisiun. "There is guilt if they do and guilt if they don’t.” ho said. A directive helps guide such decisions. "None of these documents hy themselves or in combination is as important as good solid discussion with a spouse, family and doctors about what somebody wants,” Wheeler said MOVING??? Make it a smart move with Ryder -1 STUDENT DISCOUNT COUPON For rates and information call 683*3384 3 convenient locations 20% Discount 10% Discount On One Way Moves On Local Moves expires 6/22/87 SAVE *501 AtK arvrd SiUJium' college rmgc are now more affordable than ever t hnw Irom an mcri-diW. variety ot vlylrv “’** your ArtCarved refirrsentattve now and cave $40 on a girat Siladium , ollege ring tverv ArtCarved ring i> backed bv a Full latetime Warranty 13th A Kincaid M F 7 30-5 30 SAT 1000-4 00 MS-4331 Wed., Thure., June 3, 4 1 0:00-3:00 UO Bookstore The Saga Continues WEDNESDAY NIGHT at TRACK TOWN PIZZA Get a medium (12**) One-Ingredient Pizza for ONLY . . . Why settle for less . . . than the BEST!?! 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