Massachusetts and many other states allow residents to designate another person to make medical decisions for them in the event they are ever mentally incapacitated.
In Massachusetts, this is called designating a healthcare proxy. In some other states it is also called a medical power of attorney. The process is fairly simple, and federal law requires that hospitals ask anyone getting care whether they have a healthcare proxy or similar document. But only about 15 percent to 20 percent of Americans have taken this step, according to a study completed in 2002, leaving them vulnerable to the type of legal battle now raging over Terri Schiavo. Nearly half of Americans say they would rely on friends or family to carry out their wishes about end-of-life care, but most have never told anyone exactly what they want.
Specialists recommend that everyone over 18 designate a healthcare proxy. ''Tragedy can strike at young ages," said Margaret Ann Metzger, executive director of the Massachusetts Commission on End of Life Care. Schiavo was 26 when she became mentally incapacitated after suffering a heart attack.
There are signs of increased interest in proxies because of the Schiavo case. The number of people viewing a Massachusetts Medical Society website that provides a health proxy form jumped from a handful early last week to more than 100 on Saturday.
''Living wills," documents in which people spell out their wishes for specific circumstances or specific procedures, are not legally binding in Massachusetts, and specialists warn that they can be problematic since they may not cover the specific situations that eventually occur. Dr. Michael Grodin, director of medical ethics at Boston University medical school, suggested instead that people write out some general guidelines and give them to their health proxy.
The health proxy will only make decisions for you if your doctor decides that you are not capable of understanding your circumstances and making decisions for yourself.
To designate a proxy, select someone you trust who will be a forceful advocate for you. It can be a spouse or other family member, or someone unrelated. Have a detailed conversation with that person about your wishes. You may want to write down some specific instructions, such as not wanting tube feeding, and give it to the proxy. Fill out a proxy form and sign it in the presence of two adult witnesses. Keep the original where it can be easily found and give copies to your doctor, your healthcare proxy, family members, and your lawyer. Carry a note in your wallet that says you have a proxy and where emergency workers can find the original.
The free forms, and advice, can be found at:
www.healthcareproxy.org -- a site run by the Massachusetts Medical Society
www.betterending.org -- a site run by the Central Massachusetts Partnership to Improve Care at the End of Life, 508-767-9877
Massachusetts Commission on End of Life Care -- www.endoflifecommission.org
Harvard Medical School Guide to Living Wills and Health Care Proxies, $14 -- www.health.harvard.edu, or 1-877-649-9457