Living wills: Five Wishes type catching on in Nevada

Bruno Petrini doesn't know when or how the cancer coursing through his body will take his life.

But he knows exactly how he wants doctors to treat him until then.

"I want to be treated like a human being," Petrini said from the recliner in his room at the Nathan Adelson Hospice center.

"Everybody's entitled -- like if they need drugs because they're in a lot of pain," Petrini said. "You've got to die in a reasonable way."

That's the purpose of an advance directive, commonly called a living will. It allows people to decide while they're healthy how they want to be treated when they're nearing death.

In Nevada people must use the format detailed in state law in order to file a legally binding advance directive. The same goes for filing a "durable power of attorney," which is how people appoint someone to make health care decisions on their behalf when they are unable to do it for themselves.

Critics say the Nevada forms are tough to decipher and don't cover all the issues that are important to a person who is dying, such as how they want others to treat them and where they want to die.

They advocate use of a living will called Five Wishes, a document created by a Florida nonprofit organization that is gaining national popularity and is used in 33 states.

"The Five Wishes is just a fabulous tool," said Pamela J. Howle, program officer for the Nevada Center for Ethics and Health Policy.

"It's a nice way to start a really difficult conversation," Howle said. "Nobody wants to talk about death. But it's the one thing none of us is ever going to avoid."

Howle's group is a statewide partnership based at the University of Nevada, Reno's Sanford Center for Aging. It was created to address health care policy and ethics and most recently has focused on end-of-life issues, Howle said.

The 125-member group has come up with a plan of action that calls for educating residents and medical professionals on the importance of planning for that time in life when death is imminent and decisions are hard to make, she said.

But come 2001, Howle and her cohorts will take their cause to the state Capitol in hopes of making the Five Wishes or a similar document legally binding in Nevada.

"The approach in Nevada doesn't work because when you are forcing people to use a state form, you're forcing them to use someone else's words or a doctor's words rather than their own words," said Jim Towey, director of Aging with Dignity, which created the Five Wishes.

Such rules are rooted in good intentions, Towey said. Many lawmakers believe advance directives are more likely to be honored and followed if everyone uses the same forms.

But it's not true, he said. Advance directives in states that require certain forms are no more likely to be honored than in the 33 states that allow living wills written in laymen's terms.

"What increases compliance by doctors is that patients have talked to their families and to their doctors about it," Towey said.

Towey also is critical of the page-long, 10-point warning Nevada law requires on the durable power of attorney form. He said the warning is intimidating and unnecessary.

"It's not hard enough to talk about death. You've got to scare them about signing the form," he said.

Five Wishes puts such decisions in plain language.

"If you use the Nevada forms, your conversation will sound something like this: 'Hey Mom. If you're in a coma, do you want a ventilator?' " Towey said.

"With Five Wishes we talk about 'help with breathing' or 'food and water.' It took what the lawyers and doctors cooked up and put it in regular English," Towey said. "People can use this in the living room."

Sparks resident John Manion already had a living will when he moved to Nevada from the Chicago area a couple of years ago. But just to make sure he was covered he filled out Nevada's forms, which he says are "not in English."

"The Five Wishes is easier to understand and much easier to work with. You just fill in the blanks," Manion said. "There are no mysteries."

He has ordered 1,000 copies of Five Wishes from Towey's office, some of which he sent to his classmates from the Notre Dame University Class of 1956. He figures anything that makes it easier for folks to plan for life's tough decisions is worth $300 in postage.

The American Medical Association has been sending out a sample advance directive form for at least four years, Mike Lynch, spokesman for the group's national office in Chicago, said.

The AMA wholeheartedly supports the Five Wishes because it helps people tackle a very tough subject. People just need to make sure their requests are spcific enough, he said. They need to define terms such as, "heroic measures."

Sugar Vogel, an attorney and program director for the Senior Citizens Law Project sponsored by the city of Las Vegas, said her office fills out advance directives for about 1,000 seniors every year. The legal advice and filing is free for anyone age 60 or older.

Nevada forms and laws pertaining to them are pretty simple, she said.

"But less complicated is always better as long as it exercises the person's right to refuse medical treatment," Vogel said.

Many of the people pushing for more liberal living-will laws know firsthand how difficult making those decisions can be when the crisis already has hit, Howle said.

Howle's father died six years ago after a five-month battle with cancer in which he was treated by two oncologists and endured aggressive, devastating chemotherapy treatments before learning about his true prognosis and choices.

"In reality it had spread so far some of the medical treatments almost killed him," she said. "Between changing physicians, my father felt so helpless that he was begging my mother for a gun."

Had the family been aware of and able to use a simple document like Five Wishes to figure out how they wanted to die before they were faced with the situation, his last months would have been easier, Howle said.

The easier way is available, and Nevadans should be able to use it, she said.

Petrini agrees. If regular people are going to plan how they want to die, they should be able to do it in regular-people language.

"You only think about things like this when you have money in your pocket. If you're the guy who comes home with the six-pack of beer, you don't think about it," Petrini said. "I think the legal forms should be easier to fill out. They should be easier to read for people."

archive