BoomerGirl Diary

Charlotte, N.C. — Marilyn Morenz teaches seminars on making medical decisions at the end of life and how to fill out living wills.

Of all people, this nurse and director of community education for Hospice & Palliative Care Charlotte Region knows what to expect and how to prepare for death.

Still, last February when her 80-year-old mother became seriously ill with advanced breast cancer, Morenz was surprised by how difficult it was to decide to stop life-prolonging blood transfusions that were no longer working.

"You think you're ready, and you're just never ready," she said. "And we had everything in order. If I had had to face that having never had a conversation with my mom and without a living will, I don't know what I would have done. It's such a final decision. I'll think about it for the rest of my life."

Morenz and her mother had talked many times about end-of-life decisions after Morenz's father suffered a stroke in 2000 and moved to a nursing home in Connecticut.

"My mom would say, `I don't want this for myself.' She begged me never to put her in a nursing home. She wanted what she considered to be a good quality of life."

Morenz also helped her mother execute a living will that expressed those wishes. "You're not asking for euthanasia," Morenz said. "You're asking that nothing be done to try to keep you living in a condition that's unacceptable to you."

The value of discussing and documenting end-of-life wishes before a crisis became dramatically clear in 2005 through the case of Terri Schiavo, a Florida woman whose husband and parents disagreed over whether to withdraw her feeding tube.

Schiavo, who had suffered brain damage and was unable to speak or care for herself, did not have a living will, and the debate over treatment reached Congress, the president and the federal courts.

Fortunately for Morenz, both her mother, who died in February, and her father, who died in October, had living wills. She felt she understood what they wanted, and she had been legally designated to make health care decisions for them.

She was still grieving for her mother when her father developed pneumonia. The oral antibiotics he was given didn't cure the infection, and she decided against putting him in the hospital for stronger IV antibiotics. Instead, he received comfort care in the nursing home.

"Most of us, once we reach a certain point that only we can define, would want no further attempts to keep us in that state," Morenz said. "Give your family the gift of putting it in writing."

What you need

If you've signed advance directives in another state and then moved, they are probably good. But it's a good idea to sign the most current forms in the state where you live.

For example, state laws in North Carolina and South Carolina give competent adults the right to make their own health care decisions - including the right to refuse treatment - and to die a natural death. Laws also provide for people to give "advance directives" - living wills and health care powers of attorney - to explain what they would want if they become unable to speak for themselves because of illness or injury.

Both state legislatures have approved specific forms for the living will and health care power of attorney. These forms give immunity to doctors who follow them in good faith. But you don't have to use the state-approved documents. And you don't have to hire a lawyer to make them official. All you need is two witnesses to your signature and a notary public.

What is a living will?

It's a document that outlines hypothetically what kind of care you would want if you are permanently unconscious or terminally ill and close to death. It offers multiple options, such as whether you would want artificial feeding and hydration or a ventilator if you have irreversible brain damage. It also allows someone to say they want aggressive comfort care instead of life-prolonging treatment. The document must be signed by two witnesses and a notary public. Even then, health care providers don't usually follow a living will without first discussing options with a patient's family members or health care power of attorney. So it is important to talk to loved ones about your wishes in addition to expressing them in writing.

Five Wishes is a detailed living will document that addresses emotional and spiritual, as well as medical, needs. Details: 888-5WISHES (594-7437); www.agingwithdignity.org.

What's a health care power of attorney?

It's a document through which you designate someone to make decisions on your behalf when you no longer can. It must be signed by two witnesses and a notary public. Many experts believe this document is more important than a living will because living wills take effect only under narrow circumstances, and the health care power of attorney has broader authority.

Where to keep documents

Keep originals in a safe place where family members can get them. Make copies for others, such as your health care power of attorney, family members, doctor or lawyer. Do not put your only copy in a safe deposit box. Documents can be nullified or changed at any time.