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    Making Your Last Wishes Known

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    Make sure you discuss your wishes with your doctors, proxy, and family members -- in part so they won't try to contradict your instructions later. "The completion of a health care directive doesn't end when you sign the document and put it in a drawer," says Carol Sieger, staff attorney with Partnership for Caring. "Paint a picture about what's acceptable and not acceptable, what your personal values are, your idea of independence. What are your wishes regarding care? What do you view as quality of life? "

    No matter how complete your living will, you won't be able to address all possible scenarios. "People don't have crystal balls," says attorney Charles Sabatino, counsel to the American Bar Association Commission on Legal Problems of the Elderly. "Each medical decision is unique and fairly complicated. I've never seen a directive that didn't take serious interpretation to figure out how to implement it."

    That's one reason to carefully consider your choice of a proxy; Sabatino calls it "the most important decision you're going to make." Choose someone you trust implicitly but remember -- the person closest to you may not necessarily be the best option. For instance, your loving wife or grown child may be so unwilling to let you die that they'll want to resuscitate you even if you're past recovery. When you've made your choice, make sure he or she knows your philosophy about end-of-life treatment.

    Because values and wishes change over time, you should revisit your advance directive every few years and certainly after a major life change, illness, or death in the family. "If you don't update your instructions periodically, people will doubt those are still your wishes," says Sabatino.

    Regardless of their imperfections, an advance directive "remains the clearest and best avenue for insuring that patient wishes are honored at the end of life," says attorney and bioethicist Paul W. Armstrong. "Granted there are difficulties with them, but there should always be deep ambivalence about making end-of-life decisions."

    Loren Stein, a journalist based in Palo Alto, Calif., specializes in health and legal issues. Her work has appeared in California Lawyer, Hippocrates, L.A. Weekly, and The Christian Science Monitor, among other publications.

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