Thanks to the more-heat-than-light arguments surrounding the health reform proposals, how an individual might choose to die, if in a terminal state and unable to make decisions himself or herself, is again a topic of discussion. The article "Preparing for the Final Hours," from The Wall Street Journal, written by Melinda Beck, discusses the desirability of providing for what one wants to happen in the event his or her fate has to be determined by a third party (fortunately, not so likely to occur as feared). We inserted "again" because this kind of hubbub was most recently generated by the Terri Schiavo matter. Well before that, and what first prompted many people to deal with this issue, was the case of Karen Quinlan, who, after lapsing into a permanent coma in April of 1975, lived until 1986 even though she was taken off her respirator in May of 1976. (In addition to alerting everyone to the problem, this case also showed that it is not just the elderly, or even the mature, individual who needs to be made aware of what can happen-Ms. Quinlan was just 21 when she became comatose.)

The WSJ article deals with many important aspects of this topic, and we recommend that you read it in full. A couple of additional points:

1. Although one can be as detailed and explicit as desired in stating one's wishes, and we have forms for this purpose, most of our clients choose instead to use the Advance Health Care Directive kit prepared by the California Medical Association. The form in this kit will allow for as many specific directions as one could want, but it also allows you to leave every decision up to the agent you have designated, under the assumption that you will discuss what you want with that trusted person prior to appointing the agent or right after you have done so. (We have the kits, and you can order one directly from the CMA website.)

2. Many a client has nervously joked about not wanting to appoint someone who might "pull the plug" prematurely, in order to inherit earlier, for example. We can reassure the client that the attending physician will never let that happen and, warn the client to be sure that his or her wishes not to be kept alive in certain situations would be respected. That is why it is so important to discuss the matter with the proposed agent, who may be reluctant to have this responsibility, even when told what the client wants.

This is a subject that most of our clients have dealt with and covered satisfactorily. However, for those who have not, we suggest that they do so, even though the fact that they have not may indicate a reluctance to confront what, understandably, is not the most pleasant of subjects. Also, as mentioned above, end-of-life decisions sometimes have to be made for those in the prime of life, like Terri Schiavo and Karen Quinlan.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.