In her 16 years as an in-home and hospice nurse, Merle Burgener saw some families ripped apart making end-of-life decisions for a dying parent or spouse. Sometimes, family members wouldn't know what the person wanted and would argue over how best to care for them.
"At a time when the family should cling together, it really kind of tears them apart," said the retired Boise nurse. "We don't talk about it enough, and we don't talk about it early enough."
That's why Burgener, 71 and in excellent health, filled out a living will in her early 60s. In it, her daughter has legal power of attorney to make any decisions not clear in her instructions. Her daughter now knows what to do if Burgener isn't able to speak for herself when the time comes.
Starting today, changes in Idaho law will give Idahoans more freedom on end-of-life decisions.
A new form, the Physician Orders for Scope of Treatment, will be available today for patients and doctors to fill out together. Unlike existing advanced directive forms, it will be valid in every health care facility in the state and can be filled out by anyone, not just those with terminal conditions.
It is one of several hundred new laws that take effect today, including increased fees for boat owners, more time for victims of child sexual abuse to pursue civil cases, and no more smoking in bowling alleys.
Health care workers are hoping the new form will encourage more people to take action to protect their end-of-life priorities and talk to family members about their decisions.
In the old system, patients had to fill out separate paperwork at every hospital and nursing home, and file additional instructions with paramedics.
Even living wills have limited application, said Pete Sissen, a Boise attorney specializing in legal issues for the elderly. Their instructions are valid only if a physician determines you're terminal and death is imminent or if you're in a "persistent vegetative state."
The new form is valid at any hospital or ambulance in digital or printed form. It can be filed in a secretary of state database that physicians and hospitals can check. Patients also can wear a wristband that alerts doctors and emergency workers to their new instructions. The new law also says old forms and directives will take a back seat if there are any conflicts with their new instructions. It can be canceled by the patient.
For more than 20 years, registered nurse Jill Anderson ran a program for patients whose hearts were failing. She watched patients suffer as they restated their wishes over and over in repeat hospital visits.
"That would be a big stress to them," said Anderson, who works with heart patients at Saint Alphonsus Regional Medical Center. "Every time they had to talk about it again, it was very difficult."
Health care providers hope the new form will encourage more people to think ahead and prompt conversations with family members and other loved ones.
"Studies have shown that family members and physicians often misinterpret what people would want," said Dr. Kevin Clifford, an expert in care for terminally ill patients at Saint Al's. "To ask somebody who is frightened, sleep-deprived, emotionally distraught and medically naive what to do with their spouse is traumatic."
People need to realize that if they don't make their own decisions — or name a loved one to speak for them — the state will make those decisions for them, Clifford said. And the default is to take every measure to keep patients alive, he said.
Clifford said he hopes patients will have frank conversations with their doctors while filling out the form, and that it will help Idahoans understand the medical realities of certain procedures.
For example, Clifford said, when people make decisions on whether they want cardiopulmonary resuscitation, they should know that the survival rate varies greatly based on their medical condition. Heart attack victims can see survival rates of up to 70 percent. That rate drops as low as 2 percent with other diseases and can be very traumatic, he said.
"They don't have an understanding of how distressing it is to have a partial recovery," Clifford said.
Clifford said he hopes everyone will be empowered to talk over these issues with their doctor, including people who want aggressive measures taken to keep them alive.
For example, Gerald Voss, 68, of Lowman is recovering from hip surgery at the Boise Veterans Affairs Medical Center. He has hip and back injuries from his time in the Air Force.
Voss is not terminal, but he and his wife, Norma, have living wills, he said. Voss' living will says he wants to be kept alive for two years if he is not in any pain, in order to allow Norma to get his Social Security checks and other benefits.
"If I'm alive, and I'm not in any pain, until she gets her feet back on the ground, I want to be kept alive," Voss said.
But Voss also made another plan to help his wife. He has given someone else his medical power of attorney. He said he doesn't want Norma to feel badly about making the end-of-life decision for him.
"The lifeline you got to hang onto is not cruel. It's a tool." Voss said. "Nobody wants anybody to die so they have a tendency to not look at it, to shove it aside. But you can lose everything."
Shawna Gamache: 377-6416
