Gannett News Service

Only about one in three Americans have spelled out whether they want life-sustaining medical care if they become terminally ill or incapacitated, according to a 2004 survey from FindLaw legal Web site.

One way to make your wishes known is through a living will. Here are some common questions and answers about living wills and medical power of attorney:

Q: What is a living will?

A: A living will is a legal document that specifies how someone wants to be treated medically if he or she becomes incapacitated.

One person, a relative or good friend, also should be designated to make the medical decisions if the person who creates the living will cannot make the decisions himself or herself. That's called giving medical power of attorney.

Q: Why would I need a living will?

A: Medical advances now enable machines to keep severely brain-damaged and comatose patients alive, breathing for them, aiding circulation and feeding them nourishment and water.

Health-care providers will use any means available to them to prolong life unless they're directed otherwise. If a person does not want to be hooked up to machines long term to prolong his or her life, he should let family members know and prepare a living will.

Conversely, if a person wants long-term life support no matter what, it's also best to make those wishes known.

Q: I'm not married, don't have kids and am not ill. Why should I bother with a living will now?

A: More than a third of states have specific lines of succession relating to who can make medical decisions if you cannot do it for yourself and don't have a living will. Generally, spouses are first in line to be allowed to make decisions for their husband or wife.

For gay and lesbian couples and other couples who are not married, a medical power of attorney and living will are critical if people want their partners to make medical decisions.

Otherwise, physicians generally default critical-care decisions to a blood relative.

Q: How old do I have to be to have a living will?

A: A serious accident could happen to anyone, so every adult older than 18 should prepare advance directives, what a living will and medical power of attorney are called collectively.

Several landmark legal cases dealing with the rights of individuals to refuse unwanted medical treatments -- including Terri Schiavo now in the news; Karen Ann Quinlan, who spent almost 10 years in a persistent vegetative state until her death in 1985; and Nancy Cruzan, left permanently unconscious after a 1983 auto accident until her death in 1990 -- have involved people who became debilitated when they were younger than 30.

Q: If Schiavo had a living will, would she be at the center of a legal battle today?

A: Clearly spelling out your wishes can help you avoid ending up like Schiavo, 41, a Florida woman who suffered severe brain damage in 1990 after her heart stopped, experts say.

But having a living will is no guarantee. The wills don't always work because they often are too vague, can be difficult to understand, aren't always followed, and can be expensive, according to a May 2004 study for the bioethics journal The Hastings Center Report.

In another survey, intensive care unit doctors believed that just 8 percent of their patients had advance directives. In fact, more than 20 percent had.

Another Floridian, Lucy Pastore, 82, had congestive heart failure, wrote an advance directive and gave one of her daughters power of attorney, making the daughter the final health-care decision maker. She and her family passed along those wishes to everyone they could think of, including relatives and health-care professionals.

But one day, Pastore's heart stopped while a hired caregiver was bathing her. The caregiver didn't know about the advance directive and dialed 911. The first responders did what they were legally obligated to do in the absence of a written advance directive: They tried to save her. So did the hospital. Only later was the family able to persuade doctors to take her off life support. It took about four hours for her heart to stop beating.

In Schiavo's case, some doctors say she is in a persistent vegetative state, and her husband, Michael Schiavo, says he once promised his wife he wouldn't keep her alive by artificial means. Her parents have been battling to keep their daughter alive.

Q: Why aren't advance directives always followed?

A: Many factors cause the problem.

Doctors are trained to cure illnesses and repair mishaps, not help people die. No one relishes telling a patient he's terminal, so doctors and patients may hold out hope until the bitter end.

It also can be difficult to put certain decisions on paper because the treatment may be in flux or the patient isn't cognizant.

Sometimes health providers don't know about the existence of a living will or feel uncomfortable following it. To avoid litigation, doctors often will follow the wishes of the person who is the most contentious. Dead patients don't threaten malpractice suits if their wishes are ignored.

Q: How can I create a living will?

A: A local lawyer can create one and walk you through the various options in about 30 minutes.

Your local hospital or long-term care home also has forms that are legal in your state.

The National Hospice and Palliative Care Organization offers state-specific living will and medical power of attorney forms by mail if you call 800-989-9455. The group plans to put forms on its Web site in April but does not have them available on the Internet yet. Other organizations such as the National Right to Life Committee and Aging with Dignity also offer forms for some, but not all, states.