Florida seniors wrestle with care decisions

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."

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