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Get it in writing

Whether you want to be kept alive with all medical technology available _ or for life-support measures to be discontinued if there is no chance of a meaningful recovery _ it's important to specify those wishes in writing.

Such a document will not necessarily resolve everything, but it will go a long way in making it easier to decide how long, and under what conditions, to keep a person alive. Most U.S. courts and hospital ethics committees will try to honor a patient's written wishes.

In addition, a living will could lessen the guilt a relative might feel, particularly about starting or stopping life-support systems. It also could help prevent costly, lengthy and bitter family feuds when the desires of the patient are known.

A health-care proxy also should be designated to make decisions on one's behalf. Usually a spouse, parent or adult child of the patient is chosen, but sometimes the choices might be too difficult for them _ such as when a patient would want to forgo life support. In most states, the proxy can be anyone over 18 other than a health-care provider.

It is important to discuss one's choices with the proxy, so he or she knows what must be done.

The document must be properly witnessed (most states require the advance directive to be notarized and signed by at least two parties who have not been designated as the patient advocate, health-care provider or an heir of the patient).

Copies of the document should be discussed with and given to family members and/or close friends, as well as the person's physician and hospital.

The directive should be included with a patient's medical chart. Hospitals are required by law to provide information about advance directives to people in their communities and to ask each patient upon admission if he or she has one, and if not, if they want one.

Living will

Documents, which vary by state, also can be obtained online.

Partnership for Caring provides specific advance directive forms for each state at www.partnershipforcaring.org.

Aging With Dignity offers details about getting its "Five Wishes" document ($5 for one, less for multiple copies) toll-free at 1-888-594-7437 or on the Web at www.agingwithdignity.org. The document, which is valid in 35 states, including Florida, is much easier for most people to understand than the state documents. It is much more personal, offering in layman's terms the opportunity to specify how comfortable you want to be, how you define life support, even how you want to be treated: Would you like visitors from church? Music in the room? Your bedside surrounded by pictures?

To ensure that medical-care providers anywhere you might be traveling can gain access to the document, Health Directives (www.healthdirectives.org, or (866) 633-9474), of Washington Crossing, Pa., will scan the documents and give you several wallet-sized cards specifying how medical providers and loved ones can obtain your document from the Web site.

For $15 annually, mostly paid by hospitals that share in revenues, the company will make sure the living wills are kept up to date and signed each year. The older the document, the less likely it is to hold sway in a debate, says Health Directives founder Peter Heisen.

The U.S. Living Will Registry (www.uslivingwillregistry.com) offers a similar service. Both companies provide links to basic state forms and where to get information, but will accept and scan into their computer whatever documents are provided.

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