Group warns against living wills

Standard form 'assumes you want to be starved or dehydrated to death'

Amid the national crush to fill out living wills in the wake of the Terri Schiavo saga, a California pro-life group is warning citizens against signing that state's standard living will form, claiming it could result in a painful death by starvation and dehydration.

Campaign for Children and Families, a family-values nonprofit organization, is urging people to avoid using California's Advance Health Care Directive form because it makes no distinction between food and water versus heart-and-lung machinery and other artificial life-support systems. Californians who use the state's form with its standard check-off boxes may be denied nutrition and hydration, says the CCF, and could end up dying of thirst and hunger if they fall into a coma or become otherwise incapacitated.

The state's Advance Health Care Directive is found in the California Probate Code, Section 4701.

"California's living will law assumes you want to be starved or dehydrated to death," said CCF President Randy Thomasson. "This is frightening. Most people don't know that signing the standard advance directive form could sentence you to a horrible death, by your own hand or someone else's." The California's standard form provides space for citizens to further specify their wishes, but without the extra input, the form defaults in the direction of equating nutrition and hydration with artificial life-support machinery.

The group is recommending, instead, that interested Californians use the pro-life "Will to Live" form.

In fact, the National Right to Life website provides a "Will to Live" form for every state plus Washington, D.C.

"If you sign the standard form, and then fall into a temporary coma, or become disabled in an accident, or incur brain damage that initially prevents you from talking or writing, you could literally be starved and dehydrated to death by your own signature or by the person you appoint as your health care agent," said Jan Carroll McCoy, former associate western director for the National Right to Life Committee.

The problem, say critics of California's standard "living will" form, is that by simply filling in the check-off boxes provided, the citizen gives total control over his care, including the decision to withhold and withdraw food and water, to his agent:


(1.2) AGENT'S AUTHORITY: My agent is authorized to make all health care decisions for me, including decisions to provide, withhold, or withdraw artificial nutrition and hydration and all other forms of health care to keep me alive, except as I state here.
Ironically, CCF says both the check-off options of "Choice Not to Prolong Life" and "Choice to Prolong Life" are "misleading and deadly."

The choice against prolonging life artificially with machinery opens the door for death by dehydration and starvation, since California's law defines "health care" and "treatment" as including nutrition and hydration. But even checking the box to prolong life may be problematic, say critics, since that decision puts the signer within the changing limits of "generally accepted health standards," which could conceivably encompass the denial of food and water under certain circumstances.


(2.1) END-OF-LIFE DECISIONS: I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below:
___ (a) Choice Not To Prolong Life

I do not want my life to be prolonged if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits, OR

___ (b) Choice To Prolong Life

I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.

"Given that you could be starved and dehydrated to death if you use the ill-defined standard living will, now is the time for responsible citizens to take advantage of the pro-life 'Will to Live,'" said Thomasson. "Unlike the inhumane advance directive form, having a 'Will to Live' guarantees that you will receive the food and water you need should you become incapacitated, while allowing you to make distinctions about what you might consider to be extraordinary care."

The "Will to Live" was developed by the National Right to Life Committee, and is based on the presumption that "food and water are not medical treatment, but basic necessities." It specifically directs health care providers to "provide with food and fluids orally, intravenously, by tube, or by other means to the full extent necessary to both preserve my life and to assure me the optimal health possible."

"Stop and think about it," concluded Thomasson. "Food and water is not 'artificial treatment.' Food and water is not a 'machine.' Food and water is basic care for babies and adults of all ages."