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 /ADVANCE/ WASHINGTON, Nov. 30 /PRNewswire/ -- The American Bar Association issued the following:
 As of today, a seldom used kind of legal and health planning comes out of the closet and into our daily experience. A new federal law, the Patient Self-Determination Act, effective today, is intended to help adults avoid the type of "right to die" predicament that brought the case of Nancy Cruzan and her family to the U.S. Supreme Court.
 Last year, the Supreme Court rejected Mr. and Mrs. Cruzan's request to withdraw artificially supplied nutrition and hydration from their daughter Nancy, who had languished in a state of permanent unconsciousness for seven years as a result of a car accident. The court upheld Missouri's unusually tough standard of evidence and found that Nancy Cruzan had not made known her wishes clearly enough to meet that standard.
 To encourage people to make their wishes known in writing, the new act requires most hospitals, health maintenance organizations, nursing homes, and home health agencies to provide to adults, upon admission, a statement of their rights to control health care decisions, including the right to sign a document called a health care "advance directive." Facilities must also document advance directives in patients' medical records and conduct both staff and community education on patients' decision-making rights.
 Health care advance directives include Health Care Powers of Attorney and Living Wills.
 A Health Care Power of Attorney (or health care "proxy") is a document that appoints someone to make health care decisions for you if you are unable. It may also provide personalized instructions for those decisions, including decisions about the use of life-sustaining procedures.
 A Living Will is a more limited document that spells out your wishes regarding the use of life-sustaining procedures.
 Consensus Among Medical and Legal Groups
 The major medical and legal associations praise the new act as a beneficial step toward the goal of empowering individuals to control their health decisions in an age of growing and often intimidating medical technology. Indeed, this issue is one of those rare subjects on which the medical and legal communities are in close agreement. Last year, the American Bar Association and the American Medical Association issued a joint statement in support of "the right of competent adults to express their wishes on health care interventions, even if the result is the removal of life sustaining treatment." The ABA and AMA "encourage patients and physicians to use and recognize living wills, health care powers of attorney, and other medical directives."
 New Pitfalls and Misconceptions
 Despite the positive benefits of the act, the ABA urges health care consumers to approach the subject cautiously. Considerable education of both professionals and the public is needed because of common misconceptions and misunderstandings. For example:
 1) What's a Living Will have to do with a tonsillectomy?
 When you enter the hospital for routine surgery such as a tonsillectomy, and you are asked if you have a Living Will and are told about your rights to refuse life-sustaining procedures, this does not mean that you should be alarmed about your care.
 The law requires everyone to be given information about health care advance directives and to be asked if they have one. Interestingly, almost everyone agrees that the ideal time and place to think about advance directives is not at the point of admission to a hospital or other institution. Yet, the new law requires information to be provided at that point because it is the only point that conveniently lends itself to a standardized disclosure procedure. It is hoped that the information will be discussed and acted upon within families and with one's physician at a later point in time when a crisis is not at hand.
 2) Isn't this just an old people's issue?
 Absolutely not. Naturally, more older persons face death and dying issues, but younger adults have as much or more at stake in using advance directives. This is illustrated by many of the landmark cases on this subject. For example, Nancy Cruzan was in her 20s when a car accident left her in an unconscious condition that could have lasted decades. All adults need to consider making an advance directive.
 3) Beware of "noxious form syndrome."
 One result of the act will be the appearance of countless standardized advance directive forms, many of them labeled "Living Will" and many labeled Health Care "Proxy" or "Power of Attorney" or similar term. Forms can be an aid or an ailment. Three points are important to remember.
 First, any form you use should be personalized to reflect your particular values and wishes. Don't just pick up a form and sign it. Yes, a lawyer can be a great help in preparing these documents, but a lawyer is not necessary.
 Second, the form should be an aid to communication with family and physician. It should not take the place of direct discussion.
 Third, information on how to get forms that are valid in your particular state can usually be obtained from local hospitals, offices on aging, and frequently from state medical associations and bar associations. A national group, called Choice in Dying, also provides state-specific forms. For consumers, state-specific legal requirements for forms often cause a number of problems.
 For example, the difference between a Living Will and a Health Care Power of Attorney is a common point of confusion. Even though more people are familiar with the term "Living Will," a Health Care Power of Attorney is generally preferable to a Living Will, because the power of attorney can cover a broader range of health care decisions, it can include directions like a Living Will, and most importantly, it authorizes a person of your choice to speak, interpret, and advocate on your behalf.
 Another example is the uncertainty raised when an individual uses a form that does not meet special requirements in state law, such as special witnessing rules or mandatory language. Is the advance directive still valid? The prevailing legal view is that, in most cases, the patient's directive still must be followed by health care providers, as long as it is clear what the patient wants.
 4) Do I have to do this?
 No. The act is very clear that no one can require you to sign an advance directive as a condition of care or discriminate against you based on whether you have or do not have an advance directive.
 Expert Spokespeople Available:
 American Bar Association
 -- John H. Pickering, JD
 Chair, ABA Commission on Legal Problems of the Elderly
 Washington, D.C.
 202-663-6200, or after hours, 301-229-7447
 -- Charles P. Sabatino, JD
 Associate Director
 202-331-2297 or, after hours, 703-522-1755
 American Medical Association
 -- Nancy W. Dickey, MD
 Member, AMA Board of Trustees
 Former chair, AMA's Council on Ethical and Judicial Affairs
 Richmond, Texas
 Contact: Dan Maier Communications, 312-464-5382
 American Hospital Association
 -- Gail Lovinger
 Senior Staff Specialist for Policy
 Contact: Rick Wade Communications, 202-638-1100
 George Washington University Medical Center, Washington, D.C.
 -- Jacqueline J. Glover, PhD
 Director, Program in Bioethics
 -- Gail Povar, MD
 Chair, Ethics Committee
 -- Sheila McCarthy, RN
 Director of Nursing
 Contact: Terri Abdoo, 202-994-3415
 -0- 11/30/91/1830
 /CONTACT: Lisa R. Davis of the American Bar Association, 202-331-2602/ CO: American Bar Association ST: District of Columbia IN: HEA SU: LEG

MK -- DC007 -- 7779 11/27/91 13:47 EST
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Date:Nov 27, 1991

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