UH director hopes Shiavo
case stirs many to plan
for death

Jim Pietsch, University of Hawaii Elder Law Program director, said he has been inundated with calls for information because of the Terry Schiavo case in Florida.

He hopes the controversy over removal of the brain-damaged woman's feeding tube will encourage residents to clearly express their wishes in advance about treatment if incapacitated.

Where to go for help To get forms for advanced health care directives: » Call Jim Pietsch of the University of Hawaii Elder Law Program at 956-6544. » Download from the program's Web page, www.hawaii.edu/uhelp. » Download a more sensitive document called "Five Wishes" from www.fivewishes.org. It is legally binding if executed under Hawaii's laws, Pietsch said.

Schiavo suffered brain damage after a heart attack in 1990, and her parents, Bob and Mary Schindler, and husband, Michael Schiavo, have been battling in the courts over her treatment. Her parents have tried to keep her on a feeding tube to save her life. Her husband has argued that that is "a gruesome invasion" of her rights.

That kind of situation can be avoided if people make oral or written statements to their doctor and family members with instructions about health care if they cannot make their own decisions, Pietsch said.

"In Hawaii we're blessed with very important tools with advanced (health care) directives" expressing a person's desires about life support measures such as tube-feeding, hydration and nutrition, he said.

Only about 30 percent of residents have an advanced directive, which is not a lot but is better than many other places, he said.

It was not clear in the Schiavo case what her instructions were to her husband, Pietsch said. "There was nothing in writing."

He recalled a similar case about tube-feeding in Hawaii in 1990, although it did not involve any family animosity or conflict.

Honolulu attorney Jeff Crabtree's mother, Shirley, had a serious fall while hiking and was severely brain-damaged.

"She was diagnosed to be in a persistent vegetative state," Pietsch said. There was no provision then in Hawaii for an advanced directive, and her husband petitioned to the court to be her guardian.

However, he died, and Jeff Crabtree took over as successor guardian, Pietsch said.

"The question at the time was whether it was legal to remove tube-feeding from an individual in a persistent vegetative state. Jeff asked the court to remove the tubes" and was supported by his sister and friends, Pietsch said.

The Hawaii case was going on at the same time as that of 25-year-old Nancy Cruzan of Missouri, who was brain-damaged and in a vegetative state after a car accident in 1983. Her case went to the U.S. Supreme Court, which decided tube-feeding could be accepted or refused by a patient or patient's representative, Pietsch said.

In the Crabtree case, he said, then-state Judge Daniel Heeley ruled that Hawaii's law would permit an individual or guardian to remote tube-feeding based on circumstances of the case and benefits and burdens on the patient.

Pietsch was appointed by the court to be Shirley Crabtree's guardian ad litem and report facts and circumstances, pluses and benefits of the issues to the judge, who ultimately approved withdrawal of tube-feeding.

Crabtree is out of state and could not be reached for comment. After his experience with his mother, he volunteered thousands of hours to draft living-will legislation and fight for its passage.

"Jeff has done so much as a volunteer to get the word out on advanced directives," Pietsch said. "He has done a lot of pro bono work."

Pietsch, who serves on various hospital ethics committees, said the courts, committees and institutions basically agree that a patient's preferences should be followed if he or she no longer can communicate.

He said he found letters Shirley Crabtree had written to her daughter and her son had had information about conversations she had that she would not want to be kept alive in a coma by artificial means.

"It doesn't make decision-making any easier in the sense of emotions," Pietsch said. "Nobody wants anybody to die under those circumstances." But Jeff Crabtree and his sister agreed it was in their mother's best interest, he said.

He emphasizes the importance of communication. "Talk with your families. Talk with your doctors. If you have medical questions, ask your doctor. If you have religious, philosophical or moral questions about end-of-life treatment or decisions, talk to a spiritual adviser."

The Catholic Church and other religions support the preferences of an incapacitated patient, he said, although "certain ones will put more emphasis on presumption of providing nutrition and hydration."

"Why let this happen to your family?" Pietsch said, referring to the Schiavo controversy. Family conflicts do occur, usually when there is no advanced directive and sometimes even when there is, he said.

A relative might threaten to sue a doctor who intends to follow a patient's request and withdraw tube-feeding, he said. "Sometimes, doctors will balk at the threat of a suit, but there is no case of a successful lawsuit for a doctor following desires of a patient."

Pietsch points out that most Schiavo-type cases involve young people, who should also fill out advanced directives.

"Download that form. Get two witnesses. At least talk to your doctor," he advised.

"Put it in your medical file. In a pinch, designate a surrogate to carry out decisions by talking to an attending physician."