Magdalena FelicianoAD

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Bryant & Stratton College *

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Law

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Apr 3, 2024

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docx

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Magdalena Feliciano 8/5/22 Advanced Directives Personally I believe everyone would like to be somewhat responsible for what happens to them in this lifetime and when they are ready to leave this earth. Advanced directives are legal documents that explain how you want medical decisions about you to be made if you cannot make the decisions yourself. A living will is a type of advance directive, A living will is a document that lets you outline your end of life care preferences. You can state whether you want to receive certain medical treatments, procedures, medication, blood transfusions, and more. If you’re ever incapacitated (for example, in a coma) and can’t communicate your wishes, your doctors will consult the instructions in your living will and try to follow them, as long as they’re reasonable. Without a living will, it’s up to your doctors, family members, and state law to choose what healthcare you receive. A Power of Attorney is a document that allows you to designate a trusted person to make healthcare decisions on your behalf should you become unable to make those decisions yourself. The person named in a Health Care Proxy can be given broad powers to make healthcare decisions on your behalf. Psychiatric advance directives Psychiatric advance directives (PAD), also called “advance directives for mental healthcare,” are becoming more common as society places a greater emphasis on mental wellness. A PAD is a legal document that lets you detail your preferences for future mental health treatment. You can also choose someone to make treatment decisions for you if you’re in a crisis and unable to make them yourself. It’s a good idea to check your state laws to decide if it makes sense to document your preferences specifically for mental healthcare treatment. In the Teni Schiavo case was a series of court and legislative actions in the United States from 1998 to 2005, regarding the care of Theresa Marie Schiavo, a woman in an irreversible persistent vegetative state. On February 25, 1990, then 26-year-old Terri Schiavo fell unconscious in her apartment in St Petersburg. Her husband of 5 years, Michael Schiavo, called the paramedics but did not perform cardiopulmonary resuscitation. Terri was anoxic until help arrived. She was resuscitated but never regained consciousness, and a percutaneous endoscopic gastrostomy (PEG) tube was placed to provide nourishment and hydration. It has been stated that the cardiac arrest was precipitated by an electrolyte imbalance, given that her first potassium level obtained in the hospital after resuscitation was only 2.0 mEq/L (reference range, 3.6-4.8 mEq/L). The hypokalemia has been said to be due to anorexia concurrent with attempts of assisted reproduction procedures, but given that the potassium assay was performed after her resuscitation, the actual cause of Terri's cardiac arrest remains unresolved. The police were called to investigate the situation, but the reporting officers found no evidence of physical struggle or abuse in the apartment, nor was any present on Terri's physical examination. At Terri's autopsy years later, the only sign of bony irregularity was a vertebral compression

fracture due to severe osteoporosis, which was likely due to her prolonged bedridden state, and there was no evidence of previous fractures, tracheal injury, or other signs of trauma. Despite a reexamination of the events surrounding the original event requested by Governor John Ellis Bush, prosecutors Doug Crow and Bob Lewis could find no credible evidence of physical trauma or abuse, nor of any wrongdoing by Michael Schiavo. Governor Bush subsequently closed the inquiry(MEMO,2005). After several weeks, Terri was transferred to a skilled care and rehabilitation facility. Because there was no advance directive, Michael was appointed Terri's formal guardian on June 18, 1990,by the court. An attempt at home care in September 1990, provided in the Schindlers’ home with Michael in residence, proved too overwhelming, and Terri was returned to the chronic care facility after 3 weeks. Two months later, Michael took Terri to California to pursue experimental thalamic stimulator implant treatment to improve or restore her level of consciousness. The treatment failed, and they returned to Florida in January 1991; Terri was placed in the Mediplex Rehabilitation Center in Brandon, Fla. Numerous neurologic evaluations revealed only reflexive behaviors consistent with a PVS(persistent vegetable state). Multiple swallowing studies showed severe oropharyngeal dysphagia, but Terri continued to receive intensive physical, speech, and occupational therapy. Michael continued to live in the Schindler home for several more months until May 1992. He was fixated on Terri's care for the first 4 years after her cardiac arrest. In 1994 Micheal changed his mind from believing Terri would recover to believing she would never improve. He wanted to change Terri’s status to “Do Not Resuscitate”. The relationship between the two changed when the two were rewarded malpractice lawsuits. Speculation was made that it was due the money that their relationship went sour. The truth will remain unknown, on July 29, 1993, the Schindlers petitioned the court to remove Michael as Terri's guardian. Because no basis was found for such removal, the suit was dismissed. Four years later, in May 1998, Michael petitioned the court to authorize the removal of Terri's PEG tube. Because the Schindlers opposed this petition, claiming that Terri would have wanted to be kept alive, the court appointed a second guardian ad litem, Richard L. Pearse, to serve on behalf of Terri's interests. In December 1998, Pearse issued his report, which noted that Terri was in a PVS and, according to her treating physicians, had no chance of improvement. Consequently, when the Schindlers testified in their depositions that, if they were to act as Terri's surrogate decision maker, they would insist on maintaining the feeding tube and all life support even if Terri had left written instructions to the contrary, 10 they disqualified themselves from ever being appointed proxies. Despite the Schlindlers’ own perceived good intentions, no judge could grant them responsibility for Terri's care because they had declared that they would ignore the fundamental ethical and legal requirements of a proper surrogate. The actions on behalf of the husband in my opinion were ethical. He loved his wife and stood by her through the difficult times even though decisions became difficult. I believe he had his wifes best interest at heart. He knew her best after all these years and was said to have made multiple statements regarding never wanting to ever live as a vegetable with machines keeping her alive. After several years it can be hard to watch someone only live because of machines. As for the parents, their decisions were unethical and seemed selfish. Ignoring the suffering of their

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