Those of us who are old enough may recall when Living Wills were first introduced and popularized in the 1960's and 1970's. Later, Medical Powers of Attorney were added as important planning documents in the 1980's. Many of us also know that these documents were designed to help us write out our future health care wishes, and to appoint trusted persons to speak in our behalf in case we ever become unable to make or communicate medical treatment wishes ourselves.
Some of us remember, too, the very public court battles that occurred when people failed to complete these documents -- names such as Karen Ann Quinlan, Nancy Cruzan, and now Terri Schiavo, come quickly to mind. These were cases where medical treatment choices had to be made, but where no one could agree on what the person would have wanted, or on what should be done in their "best interests."
Court action in these matters has become so commonplace that many legal commentators now refer to the "top 100 cases" as they seek to identify key rulings, legal findings and special criteria. Profound and costly consequences have often resulted from the many thousands of such cases on record. Expensive and public court battles were pursued, and many families were torn apart with ugly accusations of neglect, abuse, selfishness and greed as each faction argued that they knew what was best.
And these are only the cases that made it to court. There are untold thousands more where profound family conflicts or even medical staff disagreements occurred, and where great discord and contention were endured and suffered, but where one side or another chose to capitulate or withdraw when faced with the daunting burdens and costs of potential court action. All this, because no one really knew -- or could not adequately prove -- what a now-disabled, silent, and very vulnerable loved one actually wanted. Witnessing these events, many people hurried to complete an "Advance Directive" (the general term that includes living wills, medical powers of attorney, proxy documents, health instruction forms, etc). The intended goal was to spare loved ones any similar distress -- and to ensure that treatments wanted or not wanted were well known in advance.
However, if you're like most of us attempting to complete these documents, you soon found yourself facing the uneasy feeling that you weren't actually solving potential future problems -- often, because the documents did not seem to comprehensively address your wishes or concerns. Looking over a newly completed Advance Directive, lingering questions likely remained:
1) Do I really know what I want done? Have I covered all important situations? Have I been sufficiently clear?
2) What, specifically, should I write down, and what should I be telling those I have chosen to carry out my wishes?
3) Why do so many of these "advance directives" focus only on refusing medical care? Can I also write down things I do want done? How can I best prevent others from making hasty or premature decisions?
4) Are statements such as "I don't want what happened to Aunt May to happen to me," or "I wouldn't want to live that way," sufficient to guide future care? How about alternative requests such as "do more," "don't let me suffer," or even "do everything"? Are these general declarations enough to adequately guide those who may eventually represent me?
These same questions were confronted by our researchers, both in their professional practice and in their personal lives. One of our researchers spent 22 years working in Emergency medicine and Intensive Care settings. Consequently, he had seen many challenging health situations and had developed some very strong opinions about those conditions and medical treatments that he would and would not find tolerable -- sometimes in very rare (but profound) medical circumstances. However, many of his concerns were not easily incorporated into a standard statutory advance directive. Reflecting on these concerns, a very personal push was soon on to produce something better.
We informally began our investigation into these problems in 1993, and finally organized as a research group in 1994. Initially, we thought that the research process would be relatively brief, and that useful conclusions would quickly be reached. But this was not the case. Issues in law, medical practice, the psychology of human nature, and a host of other concerns had to be examined and reconciled with our goals and endeavors.
Years passed. Yet, just as we would falter and consider abandoning our efforts altogether as being too complex and time consuming, we would encounter new reasons to go on -- often arising from personal and family experiences. So we continued. Finally, not long after the turn of the new century, all the elements of the research began to come together. Formal testing revealed the benefits we had hoped for emerging from our studies, and it was at last time to share the fruits of these many years of labors with others.
Please know that the Lifecare Advance Directive is not a document for the faint of heart. Rather, it is for those who are willing to answer some very difficult questions. In short, it is primarily for those who take personal planning quite seriously. If you would rather speak only in vague generalities or to make only superficial allusions to your wishes, this directive is not for you. Instead, you are then invited to download a complementary copy of your own state's standard advance directive here.
The Lifecare advance directive is designed specifically for those who recognize that "not to decide is to decide." It is for those who clearly understand the reality that if you try to avoid making these difficult decisions, the choices must still be made -- you've simply left them in the hands of others. And, in doing so you may have even consigned your loved ones to the harsh court of public opinion (as anyone can call any unsubstantiated decisions into question), or to a lifetime of guilt if they capitulate to outside pressures or press forward when they truly feel they do not know what you would want.
Therefore, is our hope that you will consider completing this challenging, but genuinely straightforward and plain-written Directive, so that you might spare your family, your doctors, the courts, and many others the tremendous stresses that can result from your prior failure to speak openly. It is our belief that, as you engage this meaningful topic, you will discover that true peace of mind comes from having dealt honestly and frankly with these issues. It is remarkable how empowering and affirming it can be to face something difficult but important, and to know you have managed it fully and well.
As you do so, please accept our best wishes for you and those whom you love.
~~ Lifecare Staff.
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