I've heard that many state legislatures/courts are working to modify
the laws governing advance directives (or just general
prior-to-incompetency orally expressed preferences) in the past few
years, particularly following the Terri Schiavo case (as in, some
states are pushing for
stricter standards in proving a now-incompetent person would have made
the decision to remove life support when competent, etc.).  In which
states have the changes taken place, and where might I find more
detailed information on what the proposed changes are/have been?

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Request for Question Clarification by pafalafa-ga on 24 Oct 2005 17:46 PDT

k4567-ga,

There's been a lot of talk about legislative reforms on this topic,
and a lot of hastily-introduced bills, but not much has actually
changed, as far as I can tell.  The legislative proposals have largely
stalled, and the debates continue.

AARP recently prepared a pretty good, if brief, overview of various
legislative proposals, which you can see here:


http://www.aarp.org/bulletin/yourhealth/the_schiavo_factor.html


I don't know if this gives you adequate information or not.  Please
have a look, and let me know what additional information you would
like to have to make for a complete answer to your question.

Thanks,

pafalafa-ga

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Clarification of Question by k4567-ga on 24 Oct 2005 18:28 PDT

This is along the lines of what I was looking for - just something to
point me in the right direction for more research.  Are you aware of
any studies that have come out on this topic in recent years?  As in,
something authoritative, or something that would point me to the
actual text of these various proposals?

---

Request for Question Clarification by pafalafa-ga on 24 Oct 2005 19:00 PDT

There's a fair amount of research on end-of-life policy issues, but
very little that provides links directly to post-Schiavo initiatives.

The closest, perhaps {in addition to the AARP summary) is this very
recent overview from the National Council of State Legislatures:


http://www.ncsl.org/programs/press/2005/pr080519LifeCare.htm
Beyond the Schiavo Case: Revisiting End-of-Life Issues
August 17, 2005


Note, in particular, this summary text:

"In the states, Keyserling noted that no significant end of life care
legislation has passed since the Schiavo case. Keyserling said the
National Right to Life Coalition has some legislation regarding
feeding tube removal, which has not met with success yet. In a few
other states, groups have brought forward legislation in a few states
regarding spousal behavior in an end of life care case. However,
difficulties in defining when a spouse is behaving badly in an end of
life case have been problematic for the legislation..."


NCSL also produced an overview of long-term-care and end-of-life
issues in a 2003 summary:


http://www.ncsl.org/programs/health/forum/ltc/ltcmain.htm
State Long-Term Care: Recent Developments and Policy Directions


In particular, they write:


"End of Life. Legislation on end-of-life issues ranged from a bill of
rights for hospice participants to pain management. California
lawmakers passed a measure allowing individuals who receive hospice
services to enter residential care facilities without having to
disenroll from hospice. The Maryland legislature established the State
Advisory Council on Quality Care at the End of Life to study the
effects of public policies on the provision of care at the end of life
and to advise the legislature on these issues. The Michigan
Legislature enacted 13 pain management, end-of-life and hospice care
bills in 2002. One of the bills creates an advisory committee on pain
management that would develop and encourage the implementation of
model core curricula on pain and symptom management. In Minnesota,
legislative activity centered on a hospice bill of rights that spells
out 22 rights, ranging from the right to be free of physical or verbal
abuse to the right to refuse treatment..."



Again, I'm not quite sure if this is on target for what you need, or
if you're looking for text of actual legislative bills on these
issues.  If the latter, you will probably need to visit individual
state legislative websites to explore particular issues.

Let me know your thoughts on all this.


pafalafa-ga