"THE LIVING END"
End-of-Life Choices:
How to Ensure Yours Will Be Honored

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This book is for everyone:

Professionals who want to better advise their clients;

Medical facilities that want to serve their patients
but avoid family disputes 
or ethical conflicts;

Individuals who must make choices for themselves and their families.

By Anita Rufus, J.D.


Chapter Outline

SECTION I:
THE RIGHT TO REFUSE TREATMENT


Chapter 1:What are our last rights?
Court decisions, from the 1891 decision that led to a requirement for informed consent because we own our own bodies, to the landmark Quinlan and Cruzan cases that affirmed the constitutional right to refuse treatment.

Chapter 2: The times they are a-changin’
Social, cultural, and policy changes regarding end-of-life choices, including movies, Dear Abby, Dr. Kevorkian, Oregon’s vote to legalize physician assistance, and Terry Schiavo.
Poll results, religious positions, and the
evolution of professional organization
policies (AMA, nurses, lawyers) 
are included.

Chapter 3: There oughta be a law!
Laws about the right to refuse treatment and allowing advance directives include
California’s Natural Death Act of 1976,
the first in the nation, and the
Patient Self-Determination Act
passed by Congress in 1990.
This chapter discusses the Act’s provisions, the result of it never being fully implemented or funded, and the recent introduction of new legislation that would standardize the use of advance directives across state lines. Differences in state laws and standards of evidence used in the courts are also identified.

SECTION II.
WHY ADVANCE DIRECTIVES
ARE NOT ENOUGH


Chapter 4:Whose life is it, anyway?
Advance directives may not be honored
by your doctor, the medical facility, or
across state lines.  The reasons run
from religious differences to lack of education and training. Family conflicts, choosing the wrong surrogate, or even financial conflicts of interest can mean your wishes are disregarded.
What can be done to get the
R-E-S-P-E-C-T
you deserve?

Chapter 5:Order in the court!
Nobody wants to end up like Terry Schiavo,
but it can happen,
even if you have an advance directive.
How do courts deal with these cases,
and what can you do to make sure you are protected if that ever happens?

Chapter 6:Who can I turn to?
Is there a profession especially trained to fill out advance directives? Lots of organizations distribute free forms tailored to each state’s laws,
and many more offer paid services.
But how can you assure you are doing
the right things to have the best chance
of your wishes being honored?
This chapter discusses all these issues, and includes some suggested language that others have found helpful, plus language to avoid. 

Chapter 7:A bridge over troubled waters
No matter how well you plan,
conflicts can arise when the time comes 
that your choices need to be made clear.
Children may not agree, or your family
may conflict with the medical facility.
Outside third parties can attempt to intervene, maybe even the governor!
This chapter is a brief overview of the kinds of conflicts that have happened in the past and how they were resolved. Mediation as a valuable alternative to court proceedings is discussed here.


SECTION III.
YOU CAN ALWAYS GET
WHAT YOU WANT!
SUGGESTIONS TO MAKE SURE
YOUR CHOICES ARE HONORED


This section of the book has twenty-five suggestions to help prepare for
end-of-life decisions.
It has practical advice, including ideas based on others’ experiences. 
For example:

Don’t wait! Complete advance directives well before the need arises, when you can discuss these issues with family, friends, and doctors before you are all confronted
with the emotions of an end-of-life situation. When the time comes, everyone should feel prepared for what you want to happen.

Have frank discussions with family members, friends, medical providers, and others,
so that if a court procedure is ever necessary
your wishes will be clear.

Appoint a surrogate who will not be subject to family pressures or guilt – not a spouse or child, but rather a good friend, lawyer, other relative like an aunt or cousin – someone who will be able to step up and fight for you.


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