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Florida Case Spotlights the Need for Advance Directives

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However, Bob Arnold, MD, an internist who specializes in the ethics of doctor-patient relations at the University of Pittsburgh, says sometimes doctors themselves are reluctant to bring up these issues. "I think that the reason they're uncomfortable is that they're concerned that if they raise it, patients will give up hope, or that they won't think that the doctor's doing all they can to make them better," he says.

Not surprisingly, only an estimated 10% to 20% of patients actually enter the hospital with specific instructions drawn up for a worst-case scenario.

"I've found that people, once they talked about it, found it quite liberating, because ... it worked through some important stuff, and they were able to put it behind them as having been decided," Garey Eakes, JD, chief operating officer and director of public affairs for Partnership for Caring, tells WebMD.

His group offers guidance to people who want to plan for the day when they might not be able to make a crucial medical decision for themselves.

While it seems intimidating, preparing a living will can be something as simple as setting out your thoughts on paper, or discussing your feelings with someone close to you. More sophisticated documents include a delegation to someone who can exercise some authority on your behalf. A healthcare declaration names an individual who has legal rights to be your agent in medical decisions.

Eakes has seen firsthand what can happen when a dispute over care erupts in a family. He was co-counsel for Michelle Finn, who fought for three years to end her husband Hugh's treatment. The one-time television anchor wound up in what was an apparently irreversible coma after being involved in a car accident in 1995. Ironically, Eakes says, just before the crash, Finn had asked a lawyer to prepare an advanced directive so he wouldn't wind up in what doctors call a permanent vegetative state.

However, Finn's family insisted that their son be kept alive, and, literally at the last minute before a Virginia court allowed the removal of Hugh Finn's feeding tube, the state's governor intervened on the family's side. Ultimately, Michelle Finn prevailed and ended the treatment in 1998, which lead to Hugh's death. A bill was then passed in the Virginia legislature giving Michelle some $73,000 in compensation.

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