Florida seniors wrestle with care decisions

Tucked away somewhere in Velma Fields' Florida home is a living will, made so many years ago that she can barely remember when she wrote it.

In recent days, however, she has been sharply reminded of the document's importance. Like many other seniors, the bitter legal wrangle over the fate of Terri Schiavo has, for Mrs. Fields, pulled into sharp focus the necessity to record one's end-of-life wishes in writing.

"I would never want to be kept alive like that poor girl," she says of Mrs Schiavo, whose husband Michael claims that his wife once told him during an unrecorded conversation prior to her collapse in 1990 that she would not want to be kept alive artificially.

"My family understands fully that they are not to let me linger like that. I don't want any machines and tubes. When it's my time, I want them to release me so I can go and meet my maker," says Fields, 75, who lives with her daughter Kay Daugherty in Coral Springs.

Across the country, Americans are rushing to pen detailed instructions about end-of-life care in the wake of the Schiavo case.

But perhaps nowhere are the discussions and the planning more intense than in Florida, the nation's retirement capital, where millions of seniors have been living with the emotional perturbations in the case for more than a decade.

Of Florida's 8 million citizens, 2.9 million are aged 65 and over. That's 17 percent of the state's population, the highest in the nation. Florida has more elders within its borders than 17 other states and the District of Columbia combined.

Around 60 percent live with a spouse and 25 percent with another relative such as a child or grandchild, according to a study carried out by the state's Department of Elder Affairs last year. One quarter of the state's senior population describe themselves as caregivers.

While making a living will is not just an issue for seniors - Schiavo, for example, was just 25 when she collapsed in 1990 and suffered brain damage - it is one that is perhaps more to the front of the minds of those in their twilight years.

Organizations such as the American Association for Retired People, and the state government, issue literature and advice on end-of-life choices, and many nursing homes require some kind of "advance directive" from their patients as a condition of entry.

Jack Hirschbein and his wife Shirley live in a seniors community in Margate, Fla., and made living wills several years ago. Mr. Hirschbein feels that it has given him "peace of mind" as he has watched the Schiavo saga unfold.

"It's very hard to make up your mind about what's gone on with this case because I believe Terri Schiavo has a very loving husband who doesn't want to see her suffer any more and wants to let her go. I think he's doing the right thing," he says. "But I think it's all gone beyond the way it should be, with the government getting involved and the president and his brother. This isn't what dying should be about. It's not the way I'd want it."

Ben Rabinowitz, an octogenarian in Coral Springs, Fla., feels strongly that Schiavo's parents "should have backed away years ago" and let their daughter die.

Both he and his wife Selma have suffered heart attacks in the past, with his wife undergoing major surgery, and have left strict instructions about their final wishes with their daughter Elise, who lives in New York.

"I looked at that Schiavo woman and her feeding tube and I told my daughter 'If that should ever happen to me, I don't want to be left like that.' She said 'Dad, I'd pull it out in a heartbeat,' " says Mr. Rabinowitz.

In 1998, Florida became one of the first states to act on rising complaints about people's end-of-life wishes being ignored, largely by hospitals and doctors confused by or uncertain about the legality of some patients' written instructions.

It convened the 22-member Panel for the Study of End of Life Care that approved a number of reforms. One was to order the state's Health Department to draw up a standard format for advance directives.

Today, all states recognize the legality of living wills, and 36, including Florida and Arizona, allow much leeway in how those wishes are phrased. In the other 14, including Texas, home to 2.2 million seniors, the state's own documents must be used.

By one estimate, one in five Americans over 18 had a living will prior to the recent publicity surrounding the Schiavo case. That figure is now changing fast.

"Requests for our 'Five Wishes' living will are up 40-fold in one week," says Paul Malley, director of Aging with Dignity, a nonprofit group that offers advice on living wills. "Most people have looked at the idea of having a living will and thought it's a good thing, but it takes a case like Terri's to make an abstract case more real. People are seeing the dangers in not making a decision."

While Florida is now considered a leader in encouraging people to deal with end-of-life care, it still comes down to individuals to ensure their wishes are clearly documented and communicated to loved ones, as the Schiavo case has highlighted.

"People think Florida is this picture-perfect paradise to retire to, but there are a lot of unanswered questions and issues for those who don't plan properly," says Linda Buettner, director of the Southwest Center for Positive Aging at Florida Gulf Coast University in Fort Myers. "They need to be very careful and give thought to what they are doing and get their wishes down on paper."

Mrs. Fields is due to remarry in July and has discussed her wishes with her husband-to-be. Her first husband, William, died in 1996. For the last three weeks of his life, he was cared for in a nursing home, where Fields signed a "Do Not Resuscitate" order.

"I told them he didn't want to be kept alive on any machines," she says. "When you pass away, it's your time. If you need equipment and tubes and your body and mind just aren't up to it any more, it's time to be released."