WHY EVERYONE SHOULD WRITE A LIVING WILL
By Robert J. Klein

(MONEY Magazine) – Life is not simple, nor is death. Four years ago, at the age of 85, Estelle Browning of Dunedin, Fla. declared, in a document called a living will, that she did not want her life artificially prolonged if she became terminally ill. She quite specifically rejected the idea of being kept alive with a feeding tube. After signing the living will, friends remember her saying, ''Thank God I can go in peace when my time comes.'' It was not to be. The next year, 1986, a cerebral hemorrhage permanently damaged Mrs. Browning's brain. Once her condition stabilized, the hospital inserted a feeding tube in her abdomen and transferred her to a nursing home. Since then, she has shown only faint signs of consciousness. She cannot swallow food or water. Her doctors and nurses have refused to shut off the feeding tube, however, because of a state regulation requiring nursing homes to feed all patients. Furthermore, Florida's law on living wills does not recognize a person's right to refuse food and drink. And so, despite her express wishes, Mrs. Browning has remained in the nursing home ever since, at a cost of about $36,000 a year. Except for what Medicare pays, the money comes from her assets. A widow whose only child died on the battleship Arizona in the Japanese attack on Pearl Harbor, she has no close relative to speak for her. A second cousin is acting as her court- appointed legal guardian in a suit to have her living will honored and her feeding stopped. In April, the Florida Appellate Court ruled that Mrs. Browning has a constitutional right to die. Nevertheless, as of early May she was still alive, while the legal process ground on. ''In judging cases like Mrs. Browning's,'' argues her lawyer, George Felos, ''the standard should not be whether she could live on the feeding tube but how long she would live without it.'' The Browning case is no argument against writing a living will, in which you spell out the medical situations in which you would not want to be kept alive. It is, instead, a lesson in the importance of making your instructions as clear and binding as possible. In 41 states that have laws recognizing living wills,* hospitals and doctors usually comply with them, although a few of these laws, like Florida's, require all patients to be fed. Scattered other states recognize durable powers of attorney for health care or health-care proxies, both of which are legal documents in which you give your next of kin or some other trusted person the power to decide, when you cannot, whether you should be kept alive by artificial or heroic means such as heart resuscitation. Everyone age 21 or older should consider drafting a living will. ''It doesn't matter how old or young you are,'' advises Giles R. Scofield, staff counsel of Concern for Dying, the nonprofit educational organization that originated the living will. ''My recommendation: if you have ever thought about what you would want done, write it up.'' You don't even need a lawyer to help you. Thanks to groups like Concern for Dying, you can fashion a valid living will for yourself. Concern for Dying (250 W. 57th St., New York, N.Y. 10107) will send you a set of forms at no charge, though it welcomes donations. Its kit includes a general form of living will, which is designed to win acceptance under whatever law applies, and a second document conforming to the law in your home state. You also get a ; durable power of attorney or a health-care proxy. To overcome potential legal obstacles in as many states as possible, fill out all these forms, advises Sanford J. Schlesinger, a partner in New York City of the law firm Shea & Gould and an authority on legal problems of the elderly.

Concern for Dying suggests language that, for example, welcomes medical steps to relieve pain but rejects heart resuscitation, mechanical respiration or tubal feeding. There is an argument to be made, however, for specifying that you do not want feeding stopped. In April, a judge in Albany, N.Y. authorized a hospital to stop feeding an 86-year-old stroke patient whose doctors testified that she was in an irreversibly vegetative state. A few days later, she regained consciousness and said she would ''like to wait'' before deciding whether she wanted her feeding tube removed. ''This case brings right into focus some of the concerns we have had about living wills,'' says David O'Steen, executive director of the National Right to Life Committee. ''People signing them often contemplate circumstances far different from those being invoked.'' To give your documents maximum authority, sign them in the presence of two witnesses who are not your relatives and have all signatures notarized. Take these other steps as well: -- Choose a person to make medical decisions for you if necessary. A friend may be more persuasive to a judge than a relative who is also your heir. Discuss your feelings with this representative before signing your living will, and periodically afterward, to make sure you are both in accord. Give this person a copy. -- Also give copies to members of your family, your physician, attorney and clergyman. Keep them informed of your wishes so that they won't interfere if the time comes to invoke your living will. -- If your doctor disagrees with any key term in your living will, you might want to change physicians. But do not give your doctor decision-making powers. As a rule, he or she cannot act as both your proxy and your physician. -- When choosing a hospital or nursing home, ask the institution to agree in writing to comply with your living will. -- Don't keep the original document in a safe-deposit box. It may become inaccessible to others there if you are stricken. Put your living will with other important papers, or have your attorney put it in his vault along with your will. -- Redate and re-sign your living will once a year. At least every five years, do the same before witnesses and a notary. Not only will a recent reaffirmation of your wishes carry extra weight with doctors, hospitals and judges, but it will also force you to reconsider your position. The idea of clinging to a life you cannot enjoy may be abhorrent to you now, but who knows? In 10 or 20 years, any thread of life may seem precious.

FOOTNOTE: *The exceptions: Kentucky, Massachusetts, Michigan, Nebraska, New Jersey, New York, Ohio, Pennsylvania and South Dakota