Question:-from Illinois--After seeing the turmoil surrounding the deaths of some family members and friends after long-term illnesses where end-of-life planning had not been done, my husband and I (both in our late 60's) decided to try to spare each other and our children as much agony as possible.

We found that getting copies of living will forms was easy, but getting someone to explain the effect of these forms to us has been quite another story. We called local hospital staff without success. Our lawyer told us that he knew very little about these matters and referred us to our physician, who has been too busy to talk to us at length. Since my husband is scheduled for major surgery soon, we want to know if you have information that you could send us.

Answer: Public interest in "right to die" issues was heightened in 1990 after the United States Supreme Court decision in the Nancy Cruzan case affirmed the right of an individual to make end-of-life decisions in advance of the event through “advance directives.” But rather than setting a national standard, the Court gave flexibility to the states to establish the parameters within which appointed agents are able to make these decisions on behalf of a patient who is unable to express his or her wishes. Then, prior to her death in 2005, Terri Schiavo captured our attention.

Simply put, the health care decision-making process -- of which end-of-life planning is a part -- involves a number of complex issues that can affect not only the patient but also family members, who are oftentimes unaware that a problem even exists until there are few, if any, options available.

In directing end-of-life and other health care decisions should you become incapable of doing so, you should answer three important questions: (1) If I am in a life-and-death situation, do I want medical treatment, nutrition, and hydration to be refused or withdrawn, and if so, under what circumstances? (2) How should medical decisions that do not involve life and death be handled if I am unable to express my wishes? (3) Which person is best suited to make these decisions should I be unable to do so?

The laws of each state authorize written "advance directives" by which you can give instructions to health care providers and agents now about withholding or withdrawing life-sustaining treatment at or near the end of life should you not be able to make your own decision at that time.

It is important to remember that (1) so long as your are cognitively capable, you will make your own health-care decisions and control your destiny, (2) by making an end-of-life decision, you will not be discontinuing pain management and comfort care, and (3) advance directives become effective only if you are no longer able to make or express your decisions.

Should you become unable to make your own decisions, need a medical decision made, and have no advance directive, most states have enacted laws which arbitrarily list those who will have priority in making these decisions for you.

Under a federal law called the Patient Self-Determination Act, Congress has required hospitals and other health care providers that participate in the Medicare and Medicaid programs to educate the public about advance directives and to maintain patient records; however, the care delivered to all patients -- whether they have advance directives or not -- is the same.

Some physicians are more inclined to speak with patients about these important issues than others. If yours won’t, try talking to a nurse who may be more in tune with your need for information. And make sure to get your documents signed in front of unrelated witnesses or a notary public, depending on the law of your state. We suggest that you consult your lawyer about proper execution, and consider signing the directives in your attorney's office.