European Stars and Stripes (Newspaper) - October 6, 1990, Darmstadt, Hesse                                A living will fever9 More a social problem than a Legal Issue by Shari Roan los Angeles times Dori Crews a healthy 31-year-old nurse from Orange calif., recently signed a simple document requesting that she not be kept on life support systems if she becomes terminally ill and is unable to make decisions for herself. Crews was motivated by a recent . Supreme court decision denying the termination of life support for a Missouri woman who has been in an irreversible coma for seven years. Quot i Don t want to be like that Quot Crews says. In a june 25 ruling the . Supreme court denied the family of Nancy Cruzan the right to remove the life support equipment because of a Lack of evidence defining Cruzana a wishes that decision health and Legal experts say has renewed americans interest in living wills documents that clarify the wishes of people before they become terminally ill and cannot speak for themselves. Across the United states people Are echoing Crews sentiments. Officials of two new York based groups that promote living wills say they have been overrun by concerned individuals since the High court ruling. And the response has highlighted the problems and complexities surrounding living wills. A i d Call it living Wilt fever. Everyone is saying i Don t want to be like that woman. What can i do i la get a living will a Quot says Doron Weber spokesman for the National Council on death and dying and the society for the right to die. The court made Clear that it supports the right to terminate life sustaining care. But it denied the Cruzan request because the family could not provide Quot Clear and convincing evidence Quot that Nancy Cruzan would wish to die. Cruzan 32, who has been in a vegetative state since an automobile Accident seven years ago had not stated her wishes in writing. Thus Weber and others say the decision has served to promote strongly living wills also called advanced directives. A the supreme court essentially gave constitutional stature to living wills Quot he says. Quot they said As Long As you have Clear and convincing evidence of your wishes you would have a constitutional right to have them honoured. It gave a new kind of  but the ruling also makes Clear that the termination of life sustaining equipment has become More of a social problem rather than a Legal Issue says Alexander Capron a University of Southern California ethicist. Experts agree that americans have not made living wills a tradition and Are uncomfortable discussing death and dying. Quot the main thing people should know is this is not primarily a Legal Issue and in some ways its not even primarily a medical Issue Quot Capron says. Quot its a matter of communication thinking through and talking through with your loved one with the advice of your doctor what you want to have  Public opinion polls have Long showed overwhelming support of living wills but Only about 15 percent of americans have them Weber says. A California study also showed that More than one third of physicians treating the terminally ill were unaware of a single patient in their care with a living will says Linda Emanuel a Harvard medical school ethicist. Many living wills Are ineffective in part because of the Lack of Well established procedures to obtain and Complete the documents and the failure of a patient or family to make the document known to a doctor Emanuel wrote in the june 9,1989, journal of the american medical association. There Are two Basic types of living wills one specifically states an individual s wishes about life sustaining care the other assigns the Power to make such decisions to a health care agent such As a relative or close Friend. Harvard ethicist Emanuel for example has published a detailed document called a medical directive it requires the Case of Nancy Cruzan seems to have prompted More people to write living wills. Individuals to Check 48 boxes specifying exactly what kinds of treatments they would want under what circumstances. She says the language in Many living wills is too vague and that such terms As Quot heroic measures Quot and Quot no Hope of recovery Quot Are relative and confusing. Emanuel s will also provides for a health care agent but she says assigning an agent to make life or death decisions without providing specific instructions places too great a Burden on that person. It might also encourage the agent to take the most conservative action. But Purdy says a general statement of ones wishes and values along with the appointment of an agent is sufficient especially if people discuss their wishes with the agent when the will is signed. Quot it s impossible to predict in Advance All of the medical situations that might arise Quot he says. Quot if people make up a detailed laundry list they might tie up the hands of the health provider and agent to make the Best decision Quot ethnic diagnosis by Warren e. Leary new York times there is a growing but cautious resurgence of interest by doctors in giving More consideration to their patients racial or ethnic background when diagnosing and treating illnesses. Mounting evidence suggests that race and ethnicity can and should be factors in evaluating symptoms while reaching a diagnosis and in determining the treatment and How the patients fare. Because of the country a sensitivity to racial issues there has been a reluctance to address race or ethnicity in Medicine except in the most obvious cases experts say. Tay Sachs disease among descendants of Eastern european jews sickle cell disease and hypertension among Blacks diabetes among some native americans and stomach cancer among immigrant orientals Are Well known conditions associated with particular groups. But specialists note that other Well known health problems although often considered ethnically Neutral May express themselves in different ways and vary in incidence among ethnic groups requiring different approaches in treatment. For instance new evidence indicates that the incidence of severe kidney failure among some Blacks Long known to be higher than that of Whites is much worse than previously believed. Research also suggests that chinese and hispanic women face a significantly greater risk of developing diabetes during pregnancy than comparable Blacks or Whites. Also Blacks with High blood pressure generally respond much better than Whites when treated with diuretics drugs that lower Salt and water Levels while orientals being treated for psychiatric problems respond to some anti psychotic drugs at doses 10 times lower than Are recommended for Whites. Proponents of increasing the awareness of ethnicity in Medicine acknowledge the problems that could result such As a Rise in racism increased debate Over the relative roles of heredity versus environment in illness and misconceptions about genetic superiority or inferiority associated with eugenics. Quot the political concerns Are real Quot said or. Robert f. Murray jr., a genetics expert who is professor of paediatrics and Medicine at Howard University in Washington. Quot there is always a desire among some to use any hint of a genetic defect against you. But ail groups without exception have genetic disabilities and people have to recognize that and move on to what we can do about  it has become almost impossible to properly deliver medical care without considering the ethnic background of the patient including the effect of both genetics and socioeconomic factors said Murray and other experts Quot the idea of emphasizing ethnicity in Medicine came up before 20 years ago during the civil rights Era Quot Murray said Quot but it was downplayed because some Felt the racial climate was too charged and there were too Many people who would use this to perpetuate their racism. Now people Are beginning to say we have to address  citing mounting evidence that knowledge of a patient s background can improve care or. Arthur c. Caplan director of the Center for biomedical ethics at the University of Minnesota said Quot you must take into account race and ethnicity. You can t ethically treat patients without considering  american society remains unsure of How to handle the idea of Equality and Medicine reflects this uncertainty Caplan said. With some exceptions he added Medicine generally has ignored ethnic difference in the name of Equality which has led to considering the Norm As being White and Middle class. Quot on one hand society believes it can Only reach Equality if it treats people As if they were identical interchangeable or the same Quot Caplan said. Quot but it also thinks it can Deal with Equality if it recognizes differences and makes adjustments such As special programs to assure equal Access and  or. Richard a. Williams a cardiologist and adjunct professor at the medical school of the University of California at los Angeles said that if people were becoming ill because of inborn problems or their Way of life doctors and other health professionals could not ignore it. Quot failure to acknowledge the racial or ethnic background of a patient is itself a kind of discrimination a said Williams who 15 years ago was editor of the a textbook of Black related diseases Quot an out of print volume by two dozen experts that summarized disease As it related to Blacks Quot a lot of people run away from the idea of considering ethnicity because they feet the implication is inferring inferiority or superiority among groups Quot said Williams who is completing a new Book Quot the textbook of ethnic Medicine Quot that he says addresses health problems of Many ethnic groups. Quot doctors can t be so sensitive about ethnicity that it keeps them from doing their  Page 16 a a a the stars and stripes saturday october 6,1990 Comfort in aging bashing the a a people principles old age is an imaginary state says author Alex Comfort. By James e. Walters associated press self defense against old age stereotypes is the main skill people require As they grow old in the United states. And those not yet retired must recognize a need to Quot wholly abolish the mischievous idea that after a fixed age we become different impaired or no people Quot contends a new Book. Quot As an old person you will need four things a dignity Money proper medical service and useful work Quot says author Alex Comfort. A they Are exactly the things you always needed. As things Are today you wont get them but there is no divinely ordered reason Why you should not. So either set out now to see that you do get them or work to Force society to change its posture a or do  Comfort born in 1920, originally published much of the Book in 1976 under the title a Good age. The revised and updated version in paperback from Crown publishers inc., is called say yes to old age. It details the stereotypes our society assigns to its older members suggests How to develop positive attitudes toward aging and details Many notable people from actor George Burns to French president Charles de Gaulle to architect Frank Lloyd Wright a who achieved great things in water life. Quot what is unique in our culture is that older people Are made arbitrarily role less Quot says Comfort. A some avoid this because people Are More sensible than society but it is the accepted  to change things he suggests it becomes necessary to lie Down on the tracks and say  Quot the new old will be More willing t think to do this than Are the now old when the now old were Young even in the Early Days of labor unions protest was less an Organ of orderly political change than it is  by 2010, about 14 percent of the . Population is expected to be 65 or older. Quot unless we Are old already the next a old people will be us Quot the Book says. A whether we go along with treatment now meted out to those who Are now old depends upon How far society can sell the Bill of goods it sold  this treatment it contends relies on two principles the a people principle and the expendable people principle. Quot when women were expected to faint at the sight of blood or Black people to be amiable Uncle Toms some did and were now that those rules Are seen to be demeaning or ridiculous they done to and Aren t. The trouble with the part we assign to the old is that it is the destructive part. They Are supposed to be physically and intellectually infirm slow on the Uptake and rigid in their  aging As a physical problem is real but Quot old age As it is now sold is an imaginary state which need exist Only As Long As we believe it does and impose it on people by All kinds of economic and social  Quot we can t take the pain out of the facts that humans Arentt immortal or indefinitely disease proof or that illnesses accumulate As we age Quot Comfort says. On the other hand he says at another Point Quot you need not count on illness or decrepitude. Your memory sexuality activity capacity for relationship and zest should normally last As Long As you  other Sample comments a a the chief reasonable fears Are of ill health of poverty of being the victim of attack or robbery of falling and of becoming ill while alone. Unreasonable fears fears that is Laid on us by old age role prescription include fear of losing grip on memory of being a Burden of making demands and of losing our dignity by insisting on Public entitlements for which we have  a a the word senile is less a diagnosis than a term of  a Quot there is no change in the ability of healthy people to learn up to and beyond the ninth decade of life. Using the mind preserves  a a the commonest cause of sexual no function at All Ages is performance  if the last sounds vaguely familiar this is the same Alex Comfort who wrote the Best seller Joy of sex when today s retirees were Young. James Walters worked for the associated press As a reporter and editor from 1947 until he retired in 1964. And stripes bookstores stars and stripes bookstores save $7 on this new Book by Stephen King past Midnight something happens to time that fragile concept we employ j2 to order our sense of reality. It bends stretches turns Back or snaps and Jujj sometimes reality snaps with it. And what happens to the wide eyed or observer when the window Between reality and unreality shatters and the 2 Glass begins to Fly these four chilling novellas a feast fit for King fans / provide shocking answers. It. A it a. A its a it. A5 1 i Quot a a / a a a. I a f stars co la x o b 0 o 0 cd co la 0. 1 co q z it co cd g stars and stripes bookstores stars and stripes bookstores a a a a Page 17 King with an introduction and prefatory notes to each of the tales Stephen King discusses How these stories arose in what is the world s most fearsome imagination. But it is the stories themselves that will keep readers awake Long after bedtime into those dark timeless hours past Midnight. Four past Midnight is available at the discounted Price of $15.95 regular Price $22.95 at a stars and stripes Bookstore near you. O o 7s 5 o 30 m co saturday october 1990 the stars and stripes