Why Are You at Risk if You Don't Sign a Will to Live? The Dangers in Current Legal Standards and Medical Practice.

The haunting lesson of the dehydration death of Terri Schindler Schiavo is that any of us may become unable to speak for ourselves because of an illness or the development of a disability and if so we are in very grave danger of being denied lifesaving medical treatment and even food and fluids if we have not left precise instructions to the contrary.

Why? Because the last 25-30 years have seen the rapid acceptance of "surrogacy" - - a legal term that covers the ability of another person to order the denial of treatment to someone who is incompetent but has left no clear description of wishes, theoretically on "behalf" of the incompetent patient. Let us take Arizona as an example - - a state whose climate beckons many older people to retirement there.

In Arizona, when someone who is incompetent has no relative or friend to serve as guardian, a county official, the Public Fiduciary, assumes this authority. In Pima County - - the county where Tucson is located - - a physician who works with the Public Fiduciary has testified in court that in his opinion, anyone unable to participate "at quite a high level" in health care decisionmaking would prefer to be dead, and therefore it is his policy to direct that the "artificial" feeding of any such nursing home resident be stopped.

The "vast majority" of nursing home deaths in Pima County, he testified, result from deliberate starvation and dehydration. The Public Fiduciary can and does authorize these deaths when there is no evidence of the patient's wishes. A 1987 Arizona Supreme Court ruling, Rasmussen v. Fleming, gives a guardian the authority to terminate lifesaving treatment and artificially administered nutrition and hydration, without court review or indeed any form of public record or oversight, to anyone who is "incompetent or incapacitated."

Understand the broadness of this authorization - - and of its documented application in Pima County. It certainly is not limited to those who are terminally ill and about to die in any case.

Nor is its reach limited to the extremes of impaired consciousness like coma or "persistent vegetative state." Instead, it covers people with Alzheimer's disease, mental retardation and mental illness, and even "senile dementia."

Any patients whose judgment and ability to communicate are sufficiently impaired that they cannot competently speak for themselves may lawfully be denied treatment and starved - - and, if the testimony is to be credited, that is exactly what routinely happens to the wards of Pima County.