Law Students Help Patients Complete Advance Directives

Most Americans had strong opinions about the Terri Schiavo case when the battle over whether to remove her feeding tube became a political issue and drew front-page headlines in 2005.  But many people have not taken the necessary steps to ensure that their wishes are fulfilled should they become incapacitated and unable to make decisions about their medical care. Columbia Law School students are volunteering their skills and time to help change that.

On the first Wednesday of each month, two Columbia students educate patients at Mount Sinai Hospital in Upper Manhattan about advance directives and help them file the documents to ensure their wishes are on record. The program is part of New York Legal Assistance Group’s (NYLAG) LegalHealth and Total Life Choices Project, which provides assistance to individuals seeking to take control of their health care.

Completing advance directives is especially important in New York, where state law does not recognize surrogate decision-making should a patient become unconscious or unable to communicate their wishes.

“A lot of people persist in thinking that their family can make these medical decisions, but it’s actually the doctor,” said Aviva Robin ’09, who volunteered at Mount Sinai this semester. “Families in New York are generally consulted, but it’s not legally their decision.”

Robin, who is taking Trusts & Estates this semester, saw the program as an extension of her interest in this field and an opportunity to provide one-on-one assistance to members of the community.

“End-of-life care is an area that needs a lot of work,” said Emma Neff ’10, who volunteered with NYLAG at Mount Sinai in the fall semester. “No one likes to think about death, and there can be a breakdown in communication between patients and doctors.”

The program was an opportunity for Neff to draw on her interests in law and medicine. Neff has completed two years of medical school at Duke University and will return in 2010 after earning her J.D. at Columbia to finish her M.D.

As a volunteer at the Mount Sinai clinic, Neff approached patients in the Internal Medicine waiting room, counseled them on their options and helped them complete the required paperwork so that their information and medical choices are stored in a national registry.

One option is to designate a health care proxy – the person appointed to make medical decisions should a patient become incapacitated. The designator should make their wishes known to their chosen proxy; they can also include specific instructions on the health care proxy form, such as types of treatments they would not want to receive.

The second option is to complete a living will, a document which states the kind of health care a person wants in the final stages of life. While the medical community will usually make every reasonable effort to prolong or save the life of a person, both documents allow people to state in advance what treatment they would and would not want – such as whether to forgo artificial hydration and respiration or to accept pain relief.

NYLAG reviews these documents and sends them to the U.S. Living Will Registry, which stores information in a secure online database. Patients receive a confirmation letter and a wallet-sized card with the website and a personal password, which a doctor can later use to access their information. Forms and instructions are available to the public at http://www.nylag.org/forms/TLC_%20Forms_Packet.pdf.

Columbia Law School students receive training on health care proxies and living wills prior to participating in the clinic, as well as pointers for how to approach patients.

Advance directives can be a sensitive topic to broach, and the ideal volunteer does not simply “follow a script, invade someone’s space and demand they sign a form,” said Tina Janssen-Spinosa, the coordinator of Total Life Choices at NYLAG. “You have to be able to read body language, relate to them, be patient, and be able to explain the importance and necessity of completing advance directive forms.”

The Internal Medicine waiting room is a better time and place to complete advance directives than right before checking into a hospital for a major procedure, Janssen-Spinosa said.

“It’s tough to think about these decisions if you haven’t eaten the night before and are under stress,” she said. “A good time to do this is while there are other people around you.”

The clinic sets up a table visible throughout the Mount Sinai waiting room with information packets in English and Spanish. Under supervision of a LegalHealth attorney, two Columbia students work the room, offering information to everyone who enters between 9:30 a.m. and 12:30 p.m. On some mornings, they help up to 22 patients complete health care proxies.

While just one of many opportunities for Columbia Law School students to participate in pro bono activity, the advance directives program is in high demand. Students must sign up by email, and the two slots each month fill up quickly.

“It gets taken within an hour of the email going out,” said Julian Petrin ’08, who has tried to sign up for the clinic in the past but didn’t get to participate until this semester.

“This has a nice correlation to public interest work,” said Petrin, who plans to pursue a career in trusts and estates. Speaking about the importance of advance directives across populations, she said, “Everyone needs these things.”

Columbia is one of a select group of law schools nationwide that require all students to undertake pro bono work during law school. The mandatory pro bono program – 40 hours of services beginning in the summer after the first year – grew out of a student initiative and continues to be shaped by student interests and needs as well as requests by public interest lawyers and organizations. Columbia students have contributed well over 220,000 hours of pro bono service since the inception of the requirement in 1993.

Columbia Law School, founded in 1858, stands at the forefront of legal education and of the law in a global society. Columbia Law School joins traditional strengths in international and comparative law, constitutional law, administrative law, business law and human rights law with pioneering work in the areas of intellectual property, digital technology, sexuality and gender, and criminal law.