East Valley case shows need for living will

By Mary K. Reinhart
June 19, 2007, East Valley Tribune

As Jesse Ramirez Jr. lies in a Mesa hospice and a court-appointed attorney weighs his fate, the voices of his family members are being heard loud and clear. The only voice missing is that of Ramirez. Without a living will and unable to speak, the critically injured Chandler man cannot say whether he wants to be kept alive, using all measures at all costs.

So it was that his family members - his wife on one side and his parents and siblings on the other - wound up in court last week, and Maricopa County Superior Court Judge Paul Katz ordered Ramirez reconnected to a feeding tube.

That couldn't have happened if Ramirez, 36, had an advance health care directive, or living will, and had designated power of attorney. It would have been clear from the start what type of medical intervention he wanted and who was in charge of his medical care.

"Advance directives don't do away with the historic and inherent conflicts in families. But I think they help," said Barbara Volk-Craft, program development director for Hospice of the Valley.

"It really helps people focus on the individual who's incapacitated. 'What would my loved one want?'"

Hospice of the Valley underwrites an advance directives registry, administered by the Arizona Secretary of State's Office, where Arizonans can make their health care wishes clear and readily accessible.

Launched two years ago, it's the only free database of its kind in the country and has more than 8,000 members.

Once the forms are completed, then verified and returned to the Secretary of State's Office, participants receive a password and wallet card. They have sole access to their registry information, but are encouraged to share their password with doctors and loved ones.

"I wouldn't want my children and my husband to have to make a decision that would be based totally on emotion," said Bonnie Danowski of Scottsdale, who has a living will that she plans to register with the state.

"I want all of them to be real clear about what I'm thinking so it doesn't cause any problems between them."

As the Arizona registry came online in March 2005, the debate over Terri Schiavo's fate in Florida was playing out in the courts and Congress. Hospice and state officials fielded hundreds of calls and e-mails from people who wanted to learn more about the database.

Last week, as the Ramirez case broke, there was an uptick in interest, said Deputy Secretary of State Kevin Tyne, with callers asking about group presentations and application packets. Both the state and the hospice offer public talks on the registry and advance health care directives.

Ramirez suffered severe head injuries in a May 30 crash that also injured his wife, Rebecca, 33. She recovered, and on June 8 chose to move her husband to Hospice of the Valley's Arbor Home in Mesa and stop nutrition and medical intervention.

The law gives your spouse the power to make medical decisions if you're incapacitated, including the right to refuse medical treatment. But Ramirez's sister filed an emergency petition last week asking the court to order that Ramirez be fed and arguing that his wife was not acting in his best interests.

Court papers are awash in allegations of marital infidelity, domestic violence, religious affiliation and retribution. The family is represented by the Alliance Defense Fund, a Scottsdale-based Christian law firm that takes on right-to-life causes.

Judge Katz appointed Phoenix attorney Judith Morse as Ramirez's guardian ad litem, to make recommendations on his behalf after reviewing records and interviewing family, doctors and others involved in his care. A hearing is scheduled for June 26.

The couple has three children. The crash occurred during their last day of school.

"It's tragic and sad no matter which way you look at it," Volk-Craft said. "The question is, 'Who's going to speak for you and what do you want them to say?'"

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