Terri Schiavo, the brain-damaged Florida woman who had her feeding tube removed on March 18, has become the center of legal battles, political debate and media coverage the past few weeks.
At the heart of much of the debate is the question: What would Schiavo have wanted? Schiavo, who has been in a persistent vegetative state for 15 years after a cardiac arrest, left no clear instructions for her husband or parents in the case of an incapacitating illness, so the two parties were left to wage a seven-year legal battle over whether to remove her feeding tube.
Would Schiavo's fate have been different if she had a living will directive?
That's a question many have asked, and her case has led to increased interest in living wills both nationally and locally.
"It (the Schiavo case) has made patients as well as their families more attuned to living wills" said Patsy Seger, who works in revenue cycling and as a notary for Caritas Medical Center, which offers living wills free of charge.
Seger said she has seen an increase in requests for living wills and that in the last two weeks, she hasn't worked on one without the Schiavo case being mentioned. Many of those filling out wills say they don't want to be kept alive like Schiavo.
"Some people are just so relieved after they do it," said Seger.
Jeff Yussman, a local estate-planning lawyer with Wyatt, Tarrant & Combs, LLP, also has seen increased interest in living wills among his clients, and he said that "anyone of legal age who has a concern" about end-of-life care should create a living will.
He added that Kentucky has a statute that lays out the basic requirements for a living will and forms are available from hospitals, nursing homes, the AARP and medical providers. Creating a living will does not require a lawyer.
Forms also are readily available on the Internet.
Baptist Hospital East chaplain Ted Hodge said that the Schiavo case has led to a slight increase in the number of patients asking about living wills. The hospital provides patients with living will forms, a notary and a chaplain to help with questions.
Staff at all hospitals are required by law to ask a patient if he or she has a living will, said Sharon Ruhl, a critical care clinician with Baptist East.
Ruhl said that she deals with the issue of living wills on a daily basis and that in the absence of a living will, family members may be put in "a bind" and have to make decisions based on what they think their loved ones might have wanted.
The problem in the Schiavo case is that her wishes had to be proven by testimony because nothing had been written, said Yussman.
A basic living will in Kentucky makes a distinction between life-prolonging treatment, or life support, and artificial nutrition and hydration. While Schiavo was not on life support, her feeding tube constituted artificial nutrition.
Those with living wills may choose either to withhold or not to withhold life support or artificial nutrition and hydration. They also may designate a health-care surrogate to make decisions based on their directive or to make decisions based on what is in their best interest.
The Kentucky Right to Life advocates placing end-of-life decisions solely in the hands of a surrogate because of the many contingencies involved in medical care, said Mike Janocik, assistant director of Kentucky Right to Life.
Janocik said that many living wills "choose on the side of death," and that the Right to Life's "Will to Live" directive, which is available at krla.org, chooses "on the side of human life."
Those filling out living wills may make them as specific as they like, but being too specific sometimes can lead to problems similar to the Schiavo case, said Yussman.
Yussman does recomm/files/storyimages/adding provisions regarding the Health Insurance Portability and Accountability Act (HIPAA) to a living will. This addition allows health-care providers to provide surrogates with confidential health information.
A copy of the basic living will used at Wyatt, Tarrant & Combs is available at wyattfirm.com by clicking on "areas of practice" and then clicking on "estate planning."
It is important for those who have filled out living wills to discuss their wishes with their surrogate and their families, said Ruhl. She said sometimes patients fail to do that, and surrogates are left with tough decisions because of all the different scenarios that could arise during medical treatment.
The American Bar Association offers free discussion kits at abanet.org/aging/toolkit/ to help those with living wills make their wishes clear to their surrogates. In some cases, family members can't agree on a course of action for their loved one, and even though the patient has a living will, physicians won't act against the family's wishes for fear of lawsuits, said Ruhl.
While a living will can answer some questions about end-of-life medical treatment, it can't answer them all.
"It's not the /files/storyimages/all, be all," said Ruhl.
Other Web sites with information on living wills include: uslivingwillregistry.com and agingwithdignity.org. 
