The controversy surrounding the case of Terry Schiavo in Florida points up the importance of advance medical directives, no matter what age you are.  In Schiavo there is a dispute between the parents of Terry Schiavo and her husband over whether or not to discontinue tube feeding for an individual who, according to medical testimony, is in a "persistent vegetative state."  A "persistent vegetative state" is one in which there is no activity above the brain stem so that while the automatic responses of the nervous system permit continued heartbeat and breathing, there is no cognitive function. Under Wisconsin law, a guardian of an individual in a persistent vegetative state may decide whether or not to continue tube feeding.  For other persons, such as those with severely advanced Alzheimer’s disease, or other similar conditions, the guardian may not make such a decision.

One of the major problems in the Schiavo case is that there is a dispute over Terry’s wishes, due in large part because she did not have an advance health care directive which either expressed her wishes or delegated the authority to make health care decisions to a third party.  Thus this matter, and the family’s agony, are being played out in the courts, the Florida Legislature and the Congress.

In Wisconsin, you have two options for advanced health care decision making.  A "Declaration to Physicians" (commonly known as a living will ) allows an individual to direct that no extraordinary measures be taken to keep him or her alive if the individual is in either a "terminal condition" or a "persistent vegetative state."  These actions can include turning off respirators or discontinuing feeding tubes.  In this case, no one is appointed to make these decisions for the individual–he or she simply directs what should be done.  Note that this document only applies to end of life decision.

The other, an in most cases preferable, approach is to execute a Power of Attorney For Health Care.  This document allows an individual, while he or she is able to make decisions, to designate an individual to be a "health care agent."  The authority of the health care agent only becomes effective when the person making the designation (the principal) becomes incapable of making his or her own health care decisions.  This has to be certified by two doctors or one doctor and one licensed psychologist.  Once this certification (commonly called "activation" ) takes place, the agent can make all of the decisions that the principal could have made for himself.  These can be either routine medical decisions or more complicated decisions (such as consenting to surgery or end of life decisions).  The duty of the agent is to try to make the decision he or she believes you would want made given the actual situation when the decision has to be made.

In our view, no matter what your health care wishes are, you should take the time to prepare an advance medical directive and discuss your wishes thoroughly with your family.  As the Terri Schiavo case demonstrates, this is not just something to do when you are old.  Even young persons can face these same dilemmas.  For more information, take a look at the State Bar Publication, A Gift to Your Family which can be found at: http://www.wisbar.org/bar/lifeplan/guide5.html

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