ALTHOUGH COURT BATTLES are rare, the family infighting that often results at the bedside of a client who has failed to make end-of-life plans can affect the dignity of a terminal patient’s final days.

Attorneys can ensure that their clients’ final wishes are carried out by making sure those wishes are specified through end-of-life care, or advance care, planning. And thanks in part to a Franklin Pierce Law Center professor and student, such planning is now easier.

Mitchell Simon, professor of law at Franklin Pierce Law Center and a senior scholar at the law center’s Institute for Health, Law and Ethics, was part of a recent initiative to revise the decade-old "Advance Directive," a guide to help people make and document end-of-life health care choices. The newly revised "Advance Care Planning Guide" benefited from the input of nearly 200 health care and legal professionals throughout the state. The guide is expected to be a valuable tool for clients in identifying their health care choices before an accident or illness prevents them from doing so.

The revision was a grant-funded initiative of the Foundation for Healthy Communities in conjunction with the NH Partnership for End-of-Life Care, which includes the following groups: the NH Hospital Association; NH Medical Society; Home Care Association of New Hampshire; NH Hospice Organization; AARP-New Hampshire; NH Health Care Association; NH Council of Churches; NH Nurses Association; NH Dept. of Health and Human Services; UNH-Dept. of Health Management and Policy; Franklin Pierce Law Center-Institute for Health, Law and Ethics; and NH Cancer Pain Initiative.

Simon, whose classes at FPLC include health law and advanced health law, was asked and agreed to be a legal consultant on the three-year project to revise the advance care guide. Simon had helped develop the original "Advance Directive" documents in the late 80s.

Since the Patient Self-Determination Act was enacted in 1991, hospitals and other health care organizations have been required to provide patients with information about advance directives – legal documents that allow patients to designate a health care proxy and state their preferences about medical care, written in advance of an incapacitating illness or accident. The state of New Hampshire recognizes two forms of advance directives: a living will and a durable power of attorney for health care (DPOAH).

Simon and law student Patricia Lenz, who recently graduated from FPLC, conducted an extensive review of advance directive documents and their use in all 50 states to determine how to improve NH’s guide. What Simon and Lenz found was that there is no "magic bullet," no one form that will solve all the problems of advance care planning, Simon said. "Rather than waste our energy perfecting the document itself, we (the NH Partnership) determined that we should try to clarify it, make it better, and train people to use it," said Simon.

Another component of the rewrite was surveying nearly 200 attorneys and health care professionals who regularly work with the documents, as well as individuals who filled out the original documents, to ask them what was good about the original advance directive documents, what needed improvement, what percentage of patients or clients use the documents and to obtain other information. "There was a great deal of solid research that went into this revision," said Simon.

The survey and research pointed to making the advance directives guide easier to read and understand. The typeface of the documents was changed to make it easier for elderly citizens to read, the style was modified and the language was simplified. Particular areas of confusion were also clarified.

The result is a more "user-friendly" advance care planning guide, which is easier to read and understand and contains a list of definitions and guidance on how to plan for end-of-life care and document those choices. The guide includes a DPOAH and living will that can be easily filled out.

Now that revision of the documents is complete, the NH Partnership is undertaking the larger part of the project: putting the guide to use. The group will be training about 500 practitioners and individuals in advance care planning with use of the guide.

Simon became involved in the project because his experience with health care law has shown him the importance of end-of-life planning. "If you don’t properly plan, you put your family in a very difficult position. Advance care planning is the only way to control how you want your life to end (in the event of a serious accident or illness)," he said.

"In my own experience, I have seen a lot of families battle in a way they don’t need to. Family members end up fighting over whether a parent wanted to be kept alive on machines, with feeding tubes. It’s a disservice to yourself, your family and the medical field not to specify your final wishes," said Simon.

From an attorney’s perspective, helping clients plan for end-of-life care and document those decisions helps to avoid family squabbles over the client’s final wishes, or worse, legal battles over such matters. "Lawyers do a tremendous service to their clients by helping them specify one of the major decisions they can make in their lives: how they want to spend their final days," Simon said.

"With advancing technology, the number of choices and the number of decisions individuals have to make has increased tremendously," he said. "As a matter of law, the only way you can control your end-of-life care is by executing advance directives."

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