None of us can predict whether, as we approach death, we will lose control over our minds and bodies, as Schiavo has. An advance healthcare directive, including instructions for medical care if you are incapacitated — a document often called a living will — is a tool to make our decisions in advance, and to make them known to our loved ones and healthcare providers.

Without an advance directive, unexpected and unpleasant circumstances can develop. Procedures and treatments you don't approve of may be performed on you. Loved ones may second-guess their decisions made on your behalf. Family bonds can be broken when members battle over who has the right to make these decisions.

"One of the best planning tools to avoid a situation like the Schiavo/Schindler family dispute is to use the advance healthcare directive, which in Hawai'i takes the place of what used to be called the living will," said James Pietsch, an attorney and director of the University of Hawai'i Elder Law Program.

The Schiavo case "is the worst-case scenario," Pietsch said. And that worst-case scenario can happen here.

"We do have family disputes over exactly the same type of matters," the attorney said.

An advance directive can include a power of attorney, with which you designate someone to make healthcare decisions for you, as well as individual instructions for healthcare if you cannot communicate with doctors. These instructions can specify whether you want your life prolonged if you become irreversibly ill, and whether you want a feeding tube or other means to receive nutrition and hydration.

If you do not authorize a decision-maker, your doctor can gather up family members to select a decision-maker by consensus, and doctors can work with this person to make treatment plans. But if you have not chosen a decision-maker, or this person can't or won't act on your behalf, a court could appoint a guardian to make medical decisions for you, Pietsch said.

"Sometimes in Hawai'i, the families can't reach a consensus as to who will be the surrogate decision-maker, much less what decision should be made," he said. "So the advance directive can be thought of as a gift from the patient to the family, to make these decisions in advance and to designate somebody to carry out these decisions."

Only about one in three Americans has spelled out whether they want life-sustaining medical care if they become terminally ill or incapacitated, according to a 2004 survey from FindLaw legal Web site.

The numbers are too low, Pietsch said. "Our motto at ... (the elder law program) is 'plan for the worst, and then expect the best,' " he said.

Associated Press library photo Terri Schiavo was photographed by her family on Aug. 11, 2001, in Pinellas Park, Fla.

Advance healthcare directive checklist • Talk with family members, friends, spiritual advisors, physicians, other healthcare providers and trusted people about what would be important to you if you become terminally or irreversibly ill or injured, and you can no longer could communicate your healthcare decisions or other wishes. • Ask someone you trust and whom you can count on to be your healthcare agent and discuss your wishes with this person. Select an alternate healthcare agent in case your agent is unable to serve. • Complete an advance directive, available from the University of Hawai'i Elder Law Program (UHELP), at hospitals or through various organizations. Change or cross out provisions, or make an entirely different document. Add pages if you like. • Have two qualified witnesses, or a notary, witness your signature. • Inform family members, spouse, parents, children, siblings, friends, physicians and other healthcare providers that you have executed an advance healthcare directive and that you expect them to honor your instructions. Keep them informed about your current wishes. • Give copies of the document to your healthcare agent, healthcare providers, family, close friends, clergy or any other individuals who might be involved in caring for you. • Place the executed document in your medical files. • When you renew your driver's license or state I.D, you may designate that you have an advance directive by putting "AHCD" on it. • Review the document regularly. Make a new document if necessary, and keep people informed of any changes. • Do it today! Source: James Pietsch, University of Hawai'i Elder Law Program

While you could simply tell someone the individual instructions of your advance directive, under Hawai'i's Uniform Health Care Decisions Act, Pietsch recommends you put instructions in writing, so there is no confusion about them.

Hawai'i law requires a healthcare provider to comply with your individual instructions and provides that the person authorized to make your healthcare decisions can make a reasonable interpretation of those instructions, Pietsch said.

You can also make decisions in advance on other issues, Pietsch said, such as what types of medicines you want, what hospital you want to go to, and use of your body for science.

The forms can even be downloaded off the Web, and take only minutes to complete — 5 to 10 for a short form, and about half an hour for a longer version.

In addition to taking care of the proper paperwork, people should thoroughly discuss their end-of-life decisions with family members or those who will be making the decisions for them, said Ken Zeri, a registered nurse, and president and chief professional officer of Hospice Hawai'i.

"The real truth of it is you can't put down on paper in an advance directive every single possible contingency that may happen," Zeri said. "The importance of a discussion is that your family, the people that you trust to make these decisions for you when you can't make it, have a good understanding of what you want."

That's why Samuel Rodrigues has long discussed his wishes with wife Jeri. Jeri has had several heart-to-hearts with her husband, who is now bedridden and in a hospice program.

Doctors diagnosed Samuel nearly 30 years ago with a form of muscular dystrophy, a terminal illness.

While it's still difficult for Jeri to accept her husband's situation, she has found some peace of mind knowing exactly what he wants should something happen to him.

"We've not only talked about medical wishes, but we've also talked about when he does pass away, what does he want for his funeral and important things like that," said Jeri, 46.

"... He doesn't want to have anything done to him that would prolong his life because as far as he's concerned, no matter what they do, the quality of living for him is never going to be better," she said. "... Although it's going to be hard, it's really what he wants."

The Kailua couple have openly discussed and put in writing their end-of-life decisions. Having such advance directives is crucial, Jeri Rodrigues said.

"It's really to honor the wishes of the person (who's ill)," she said. "If they should become incapacitated and can't speak or act for themselves, then it's important to know now what their wishes are."

Prepare now

It's never too early to plan ahead, Pietsch said. Terri Schiavo, for example, was in her 20s when she suffered brain damage from a chemical imbalance 15 years ago. People with older living wills should also consider updating their documents and making new advance directives.

"It's actually very easy to accomplish an advance directive, so why not just do it?" Pietsch said.

Motivated by the Schiavo case, Kane'ohe resident Mark Thomas, in his late 40s, plans to create an advance healthcare directive with his wife. He obtained forms from Kaiser and will visit a bank to get the documents notarized.

"Situations like this can happen to anyone," Thomas said.

Thomas and his wife, married for nearly 30 years, are in good health, but have discussed end-of-life matters over the years. It's time they put their wishes in writing, he said.

"The recent media coverage of the Terri Schiavo case should be a wake-up call to everybody, no matter their age," Thomas said, "primarily to settle these moral, ethical and legal decisions without putting the burden of shame, guilt or stress upon their loved ones."