An advance directive can help in planning for the end of life.

By JIM HALL

Date published: 5/25/2003

A living will can help the survivors

ELIZABETH BRANDT did her family a favor. She told them how she wanted to die.

Brandt filled out an advance directive 15 years ago just after moving from Illinois to Fredericksburg to be near her daughter. The document sat in her safe until last year when Brandt fell and broke her hip for the second time.

The 87-year-old never really recovered from the fall, and finally, as she was near death at Mary Washington Hospital, her daughter, JoAnn Sowards, pulled out the advance directive.

"I think it was one of the most precious gifts a parent can give a child," Sowards said.

As Brandt's case illustrates, an advance directive, or living will, can speak for those who are terminally ill and unable to speak for themselves.

Kimberly Hayden, executive director of the Fredericksburg-based Hospice Support Care, said that many of her clients already have an advance directive when they call for help.

Many others, though, are uncomfortable with the idea. Sometimes, when Rosalie M. Sullivan, patient advocate at Mary Washington Hospital, asks about them, patients will tell her, "I'm not old enough for that," or "I just got better news from the doctor than I thought, so I don't need it."

"I'm delighted you got good news," Sullivan replies, "but you may want to think about expressing your wishes."

The advance directive has nothing to do with "what you want to do with your stuff," Sullivan said. Instead, it represents a chance for patients to plan their final days.

In Virginia and many other states, an advance directive is legally binding and doesn't require the help of an attorney or notary to fill out.

In one of its most popular forms--The Five Wishes--a person starts by naming someone to make health-care decisions for them if they are unable. Often this person is a best friend rather than a spouse or family member.

As The Five Wishes document says, "A spouse or family member may not be the best choice because they are too emotionally involved."

The patient also lists the kind of treatment they expect if they are seriously ill and close to death. Most important, they can decide on the use of life-support measures, such as a ventilator for breathing or tubes for food, water or antibiotics.

Patients also can request that their doctor issue a "do not resuscitate" order if they're opposed to using CPR when their heart stops.

Usually, patients don't want these aggressive measures if they artificially prolong the dying process, Hayden said. With the Virginia Advance Medical Directive, a document approved by the Virginia General Assembly in 1992, the patient says he or she wants "to die naturally."

But dying naturally doesn't mean dying in pain, Hayden said. Patients almost always ask to be pain-free and comfortable.

Date published: 5/25/2003