STATE RIGHT-TO-DIE CASE ALTERS OUTLOOK ON DYING

One Missouri right-to-die case changed the outlook of an entire nation.

After Nancy Cruzan's death in December 1990, Sen. John Danforth helped promote the Congressional Patient Self-Determination Act. The law, enacted in December 1991, requires hospitals, nursing homes and other facilities receiving Medicare and Medicaid funds to inform patients about advance directives -- living wills and durable powers of attorney for health care.

Because Cruzan didn't document her feelings about life-sustaining treatment, she spent nearly eight years in a persistent vegetative state.

Linda Heitman, who serves on the Southeast Missouri Hospital Ethics Committee, said her hospital distributes information about living wills and durable powers of attorney to all patients, no matter what their illness. Neither document requires any legal expense.

Living wills are written instructions explaining a person's wishes regarding health care should he have a terminal condition. The will can be written in one's own words or prepared according to a form, but it must be signed by the individual and two witnesses, all age 18 or older.

A durable power of attorney for health care allows an individual to appoint someone to speak on his behalf if he can't make health-care decisions for himself. The document must be signed by the individual and two witnesses, and it must be notarized.

Both go into effect when the writer can no longer make or communicate his own decisions about health care.

St. Francis Medical Center Risk Manager Jan Eichhorn said the law makes it easier to discuss the dying process with patients, many of whom shy away from advance directives. She advises them to carry the documents in their wallets or purses so that medical personnel can find them immediately in case of an accident.

While attorneys aren't necessary to enact the documents, they may be called in later when living wills are contested. According to Cape Girardeau attorney Kathleen Wolz, much depends on how well the patient understood directions for completing the document.

"Some people could do their own advance directives and some couldn't," she said. "There aren't any firm statistics on how many are contested, but health care providers may be concerned about litigation. The more specific the document is, the more effective it will be."

Wolz urged communication between patients, their doctors and family members so that all of them know what should be done regarding life-sustaining treatment.