George Peltier is ready for the day when a piece of paper - posted in his home and filed in a state registry - could be the only thing between him and a feeding tube.
He is one of a growing number of Idahoans who are preparing for the possibility of being wheeled unconscious into an emergency room or otherwise rendered incapable of telling doctors whether they want to be given blood, resuscitated with CPR or sustained on life support.
There are a couple of ways Idaho allows people to state their wishes officially for treatment at the end of life or in medical emergencies.
The first is a living will. It spells out whether people want health care providers to keep them alive using various treatments. It's triggered only in certain situations - if the patient is dying or in a persistent vegetative state - and isn't carried out while a woman is pregnant.
Part of the seven-page Idaho living will form is a "durable power of attorney," which designates people to speak on the patient's behalf. The power of attorney can stand alone, and it's used in any circumstance in which a patient is unable to communicate, not just near death. But most people pair it with the living will.
The second, an increasingly popular choice, is a Physician Order for Scope of Treatment, or POST, a one-page document signed by a patient and a doctor. It offers choices similar to the living will and often is used in cases of terminal illness, but it's also used by people who for religious or other reasons do not want health care providers giving them blood or antibiotics.
About 16,500 of these forms are on file with the Idaho Secretary of State's Office, said Miren Artiach, who handles the health care directive registry for the office. That registry has been around since 2007 as a central place for doctors to find a patient's wishes. Its members receive wallet-sized cards.
Because hospitals and others are making the registry more well-known, there has been a 28 percent increase in registry filings in the past year, Artiach said. She has received about 1,000 new forms already this year.
Peltier, 83, who has inoperable cancer, is on that registry. He has a POST form and a living will.
Peltier wants his departure from this world to be similar to that of his wife. She died last year in a chair at home, in the Boise retirement center where Peltier still lives. He was sitting next to her, holding her hand.
"She and I both agreed that we just believe in an afterlife. ... We decided that we didn't want to be artificially kept alive. And that was good for her. And after she passed away, I decided the same thing was good for me," he said.
In his POST form, Peltier tells any doctor who encounters him that he does not want a feeding tube. He doesn't want to be resuscitated, either. Because the POST form is "portable," it's in effect wherever Peltier goes.
HELPING WITH DECISIONS
End-of-life and life-or-death treatment decisions are not always easy topics to bring up with a loved one. But having a conversation and filling out paperwork helps prevent confusion and heartache, according to people who work on end-of-life issues in Idaho.
"When I go out and talk about this, honestly, 90 or 95 percent of people have no idea what I'm talking about," said Casey Corbin, director of the Idaho Quality of Life Coalition.
All he has to do is mention Terri Schiavo, the Florida woman who lacked a living will when she was determined to be in a persistent vegetative state. Legal fights over her medical treatment took years to resolve.
More often than not, patients come to the emergency room with no document saying whether they want to be resuscitated or kept alive, said Rick Bassett, a clinical nurse specialist for St. Luke's Health System and the president of the Idaho Quality of Life Coalition.
"If you haven't registered, then it is very difficult for us as health care providers to determine what your wishes are," he said.
Bassett works in critical care, so many times the patients are unconscious, he said.
"In those situations, if you haven't done your advanced planning documents, it's too late. ... Now we're having to ask all the questions real-time," he said. "If I can have a document that you crafted yourself, I'm going to feel much more confident following that."
What if you didn't fill out anything? What if you didn't even write your wishes on a napkin? What happens then?
A parent or siblings could make the call. But if three siblings are the only remaining family members and there is disagreement - well, that's a problem, Bassett said.
That's when the hospital may turn to an ethics committee, which makes a recommendation based on input from medical providers and the family members. The committee asks certain questions, such as, "Do we think (the treatment) can succeed and provide this person a greater quality of life?" and "What are the risks?"
Bassett is thankful that he knew about POST forms when his mother neared the end of her life.
He was her "durable power of attorney" representative. But after a stroke, his "very independent" mother had memory problems that got worse. She ended up in the hospital. She wasn't eating.
"She was still able to talk with us and still cognizant of what was going on," Bassett said.
Before that could change, Bassett got a doctor to sit down with his mother and put her wishes on paper.
"That brought me a great deal of peace, knowing that I was able to follow this document," he said. "I knew that it was my mother's wishes. I didn't have to question anything I was doing."
Audrey Dutton: 377-6448,Twitter: @IDS_Audrey