Thinking Ahead ... to the End of Life

By Andrea B. Reiter, Pocono Record

August 3, 2010

Carol Landi, center, of Tannersville and her mother, Rose Landi, center left, of Mountainhome listen to Lori Cerato speak at Pocono Lutheran Village about end-of-life decision making during a seminar called ‘Powers of Attorney and Advance Directives: Why Do You (and Your Parents) Need Them?'

Imagine being admitted to a hospital and having the registrar ask whether you have a living will or want to write one. The questions may be unsettling, but they are required by Medicare.

The seminar "Powers of Attorney and Advance Directives: Why Do You (and Your Parents) Need Them?" was recently held at Pocono Lutheran Village, East Stroudsburg.

Arthur Kallach of Pocono Summit, when asked why he was in the audience, said, "Well, I am getting older each day."

Most were seeking information on this sensitive and often undiscussed topic.

Virginia Cosans of Mount Pocono said, "This is the stuff we need to know. This summer, we want to have our wills completely revised."

Lori Cerato of Stroudsburg, an attorney specializing in elder law and seminar speaker, said, "A living will is a document to cover the legal and medical aspects of end-of-life decision-making."

The living will in Pennsylvania is a simple one-page document. On the form, you check boxes regarding cardiac resuscitation, mechanical respiration, tube feeding, blood products, surgery or invasive diagnostic test, kidney dialysis or antibiotics. It also asks whether you want to donate your organs upon death. Cerato said that there is no age limit on organ donation.

Finally, the living will form asks whether you want to designate another person to make medical treatment decisions for you if you cannot.

"If you have no voice, your surrogate is your advocate," Cerato said. If you have opted for no treatment, your surrogate could see to it that you get at least proper pain medication.

Cerato suggested that you inform your surrogate of your choice so that the person isn't caught off-guard.

Last, get two witnesses, neither of whom can be your surrogate, to sign your document, and you've just made a living will.

Other states, such as New Jersey, require that the document be notarized.

Cerato helped participants make a living will at the end of the seminar, which was signed by the required witnesses.

You can photocopy your living will, and that will still be valid, Cerato said. Copies should be given to your doctor, your insurer, hospital, your surrogate (or alternate) and your lawyer. Cerato suggested that you carry a card in your wallet stating that you have a living will and that it is on file with your attorney.

Cerato said that the provisions of the living will wouldn't take affect unless two physicians certify that you are either incompetent and in a terminal condition or incompetent and in a state of permanent unconsciousness.

And what if there is no living will? Cerato said that in that case, the state decides who would make the decisions for you.

First in line would be your spouse. If no spouse, then your children would make the decisions. Majority would rule if you have several. If no children, your siblings are next in line. If no siblings, then any interested person can make those decisions. There has been so far no litigation about this statute.

To be sure, though, do make a living will.

"A living will makes (your medical care) your decision," Cerato said.

The living will, though, is not for everyone. Cerato said that the living will does not really cover people with various forms of dementia because they are not necessarily terminal and don't necessarily go into a permanent coma. For that reason, in 2007, the Alzheimer's Association urged the creation of a new, more inclusive document. The new document is called the "Health Care Proxy." You can add to the usual questions that it also cover serious brain injury or brain disease.

Cerato said that in a living will, your choices cannot be overridden by anyone, even your surrogate. In the health care proxy, however, your choices are only guidelines. The decisions are made by the person you choose. She explained that this can be a good thing since medicine may have improved since the document was written.

To get a health care proxy, you must see an attorney since it is customized to suit you. You do not need to see an attorney to do a living will.

The seminar was co-sponsored by Griswold Special Care and Pocono Lutheran Village, both of East Stroudsburg. The next seminar will be held 4:30 p.m. Wednesday, Aug. 18, at Riverside Rehabilitation Center on Parkinson's Road in East Stroudsburg. The topic will be "Helping People Who Have Limited Mobility."

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