More choices available when end of life is near

Under a new state law that takes effect today, North Carolinians will be able to make more detailed choices about the medical treatment they want -- and don't want -- when death is near.

Supporters say the law, which created controversy during hearings this year at the General Assembly, should make it easier for people to convey their wishes on whether to receive all treatments available or to withdraw artificial life support.

The newest component created by the law is an official directive about care that is also a medical form doctors or other health professionals have to sign. It should be available by mid-October.

"We're certainly moving forward on a fast track," said Drexdal Pratt, chief of the state Office of Emergency Management Services.

Experts recommend that families begin discussions about end-of-life care before they are faced with a crisis. Walter Newman, a resident of a Cary retirement home, says he believes that advice is critical. After a career in insurance and a bout with bad health, Newman was prompted to nail down his end-of-life decisions.

"I'm used to planning," said Newman, 81. "I had to deal with this with a lot of clients."

Newman is not at death's door; he still sells long-term care insurance. But he gathered his family, doctors and lawyers for a frank talk about what he wanted should he not be able to make and communicate decisions.

"We made sure we were legal," Newman said.

"Primarily, the intent was: If there's no hope, don't resuscitate me. If there is hope, make a judgment about what to do then."

Nursing homes, hospitals, emergency medical agencies and others have been eager to get the new medical form, called MOST for Medical Orders for Scope of Treatment, Pratt said. It doesn't replace the existing "do not resuscitate" form, which only addresses withholding cardiopulmonary resuscitation.

But the MOST form offers more options for care or withdrawal of care in a greater number of circumstances.

"It's more comprehensive," said Melanie Phelps, associate general counsel for the state medical society. "We are trying to give folks more control, even when they are no longer competent and no longer have the power to communicate."

Opponents of the new law, represented at the legislature by right-to-life groups and the Roman Catholic Diocese of Raleigh, say it leans too heavily toward withdrawing life support.

"The forms themselves are slanted toward non-treatment," said state Rep. Paul Stam of Apex, who voted against the law. "It is true that you can change the forms to say whatever you want, but the standard form, which is what the vast majority of people will use, does not reflect the desire of many people to be treated."

Whatever a person's beliefs about treatment at the end of life, hard conversations may be at hand for those who want to use the new voluntary documents.

"I've had two strokes and a heart attack, so these types of orders would be very important," Newman said.