Lodi News-Sentinel
July 27, 2001
Lodi hospital stresses need for medical directives
By Julie Z. Giese/News-Sentinel staff writer
Robert Wendland never put his wishes in writing.
It was a chore that perhaps he was reluctant to deal with.
However, Wendland was forever silenced in deciding his future medical care after he suffered severe brain damage in a 1993 traffic accident.
An advance health care directive might have spoken for him, health care officials said.
Wendland, 49, died last week after spending eight years hooked up to a feeding tube in Lodi Memorial Hospital’s transitional care unit.
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He became the center of a six-year court battle over whether his wife and conservator, Rose Wendland, could remove his feeding tube and allow him to die.
Wendland’s mother, Florence Wendland, and sister, Rebekah Vinson, fought the feeding tube removal from local courts to the California Supreme Court.
Drawing upon their experience with the Wendland case, Lodi Memorial Hospital officials are now actively encouraging patients to sign advance directives.
“All of that could have been avoided if an advance directive was signed,” said hospital spokeswoman Carol Farron, referring to the Wendland case.
Patients are offered information about an advance directive for health care when they’re admitted to the hospital as required by law, she said.
Lodi Memorial officials have also made the four-page form more accessible in the last year by putting it on the hospital’s Web site.
It’s also been redesigned to be easier to read, Farron said.
The hospital has seen an increase in requests for the advance directive forms since the Wendland case, she added.
In California, an advance directive is a legally recognized document, said Lodi attorney Doug Duncan, who handles estate planning.
The directive, which can also be called a durable power of attorney for health care, is signed by two witnesses.
The document provides doctors with information about medical treatments in the event a person can’t communicate those wishes.
A health care representative can also be appointed to make health care decisions if a person is incapacitated.
Directives can spell out decisions on care for terminally ill patients and life-sustaining treatments such as breathing machines, feeding tubes and cardiopulmonary resuscitation. It can also include direction on organ and tissue donation and authorize autopsies.
Duncan said people need to do their homework on advance directives and talk with their doctor about health conditions.
They also need to clearly discuss their wishes with whomever they appoint as a health care representative and keep the directives updated, he said.
However, Duncan said an advance directive may not have helped in the Wendland case unless it directly addressed his situation.
Most directives have provisions for medical care under a persistent vegetative state, but it’s unclear how the courts would have interpreted Wendland’s condition, he said.
“The good that comes out of the Wendland case is that some people begin to think about this before it’s too late,” Duncan said.
Directives can be written to address specific situations in which a person wouldn’t want life-sustaining measures, like in Wendland’s case, Duncan said.
But some don’t advocate that method of preparing advance directives.
“We’re absolutely in favor of advance health care directives,” said Rita Marker, executive director of the International Taskforce on Euthanasia and Assisted Suicide and an attorney based in Steubenville, Ohio.
But Marker said listing specifics in advance directives can tie the hands of those appointed to make health care decisions.
Some pitfalls can include physicians misinterpreting the specified care and denying medical treatment or if a person changes his or her mind on a certain treatment, but never updates the document, she said.
Marker does support appointing health care representatives and keeping ongoing discussions with them on preferred medical care.
The group has also developed a legal document that includes protections for patients from intentional deaths resulting from lethal injections or denial of food or fluids that would cause death by starvation or dehydration.
Information about the document is available on the group’s Web site.
Other forms of advance directive are available in bookstores or on the Internet, Duncan said.
Dr. Ronald Kass, a Stockton pulmonologist who cared for Wendland, knows the importance of advance directives all too well.
Kass, who deals with many terminally ill patients, has seen firsthand the grief caused by the legal battle over Wendland’s feeding tube.
“People who have advance directive, you don’t run into those kinds of problems,” he said.
The Wendland case even prompted Kass to prepare his own advance directive for health care.
“Every adult should have a directive because you never know when something is going to happen,” he said.
Janie Hickok Siess, a Lodi attorney who represented Florence Wendland, agreed.
Siess’ support for advance directives has been shaped by her experience with the Wendland case, she said.
“It should be very detailed and specific,” Siess said. “And if you want to consent to die of dehydration and starvation, then that should be included.”
Advance directives can also guide family members who might wrestle with decisions to end life support, Kass said.
“It’s just wise planning,” said Ken Owen of the Lodi-based Christian Community Concerns founder and director.
Owen, who once attended a rally supporting Wendland’s mother, said directives can remove many questions about health care decisions for families.
“It’s about showing love and consideration for those you leave behind,” he said.
For more information or to receive a copy of Lodi
Memorial’s advance directive forms, call the hospital at (209) 334-3411.
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