"I never want to live that way" is a common sentiment these days, making reference, of course, to the late Terri Schaivo. Folks from all walks of life seem to join in the aversion to being "a vegetable."

The Schaivo case leaves unanswered nearly as many questions as it brings to light, however. For example, Terri was not "a vegetable." She responded to changes in her environment and changes in her company. While she was unable to perform for herself nearly all of the "activities of daily living," to borrow a phrase, she was not a vegetable.

Researchers are beginning to understand a condition that has been coined a "minimally conscious state," or MCS. Persons in a minimally conscious state are aware of their surroundings to some degree and, at times, able to respond, as Terri was able to respond to the arrival of her parents in her room.

Regardless of ability to respond, many folks still feel that they "don’t want to live that way." They wish to have all supports removed, and to be allowed to die. Others feel that, while some supports should be removed, nutrition and hydration should be retained, reasoning that they "don’t want to starve to death or dehydrate."

Leaving aside ultimate moral questions, which are debatable at best, the U.S. Supreme Court most recently in the Cruzan case ruled that individuals have a liberty interest in determining their medical treatment in advance by statements that make clear their intent. State legislatures have passed laws that they have continuously modified in an attempt to keep up with the developments in the field, both legal and medical.

A well-drafted medical directive is imperative. Making known your beliefs and intentions in advance can help you avoid your own Schaivo case. Whether Terri should have been allowed to starve to death or not, perhaps the greatest tragedy of the case was the uncertainty and protracted agony of the matter. While Maryland has a "default" statute to provide for someone to make medical decisions for you if you cannot do so for yourself, it is always best to take affirmative steps to make your wishes known rather than relying on legislative grace.

Because the law is evolving in this area, and because different states have different standards for these matters, be sure your document stays up-to-date and is reviewed if you move from state to state. If your medical directive is more than two years old, it should be rewritten to accommodate changes in both federal and state law that have occurred in that time.

Many of this writer’s clients have signed the attorney general’s form of living will, generally presented to them upon admission to the hospital. This form is defective, confusing and potentially self-contradictory. Further, it does not allow for nuanced statements of belief and intent. This writer advises strongly against relying on that form.

A "living will" is technically a document that instructs your doctor as to your medical treatment. It is the growing consensus in the elder law field that a living will is not as effective as a medical power of attorney. While the former will provide for instruction, it is not responsive to changing situations or changes in the law. A medical power of attorney, in naming an agent to make decisions for you, provides for a dynamic solution that can adapt to changes in your situation, medical science and the law. This writer advises clients to use a medical power of attorney.

Make sure your medical directive is customized to reflect you as an individual, and that the persons you have named to act on your behalf understand your most deeply held moral imperatives, so that they can effectively represent you in your time of greatest need. Promptly visit with your estate planning or elder law attorney and make sure that you have effectively exercised your rights to ensure that your care reflects your values and beliefs.