What doctors need to know: Schiavo case spotlights advance directives

Physicians need to be proactive in talking to patients.

By Andis Robeznieks, AMNews staff. April 11, 2005.

If physicians haven't already been peppered with an increasing number of questions about advance care directives and living wills, they can expect to field many more soon.

There's a new interest in the topic since Terri Schiavo, a Florida woman with severe brain damage who didn't have a written directive or living will, has been at the center of recent moral and political questions surrounding her husband's decision to remove her feeding tube despite her parents' objections in court.

Organizations that help prepare advance directives say the Schiavo case, which drew action from Florida Gov. Jeb Bush, President Bush and Congress, has helped drive record levels of telephone calls to their offices and traffic to their Web sites. Experts say that doctors should expect more questions on the topic, including questions from young patients, because Schiavo was in her 20s when she became incapacitated.

If patients aren't initiating the conversation, experts also advise that physicians should be the ones to bring up the topic of living wills that guide medical care and advance directives that include instruction on medical and personal matters and name a health care proxy.

"If any good comes from a contentious case like this it is that it brings up the subject of advance directives in patients' minds and makes it more likely that patients and physicians will have a successful discussion about what directives will be created and followed," said Michael S. Goldrich, MD, chair of the American Medical Association Council on Ethical and Judicial Affairs. "The goal is to avoid conflict by making patient wishes well known or, in the absence of that, to develop a mechanism to mimic the intent of the patient through their surrogates."