The next time you go into a hospital, prepare to be presented with a living will

There is nothing therapeutic about the somber process of checking into a hospital. Already ailing and disoriented, incoming patients must fill out endless forms, produce insurance cards and steel themselves for the inevitable probes, cuts, needle pricks and medications that mark a modern hospital stay. The last thing patients want to think about is the possibility that they will never leave--that their illness or a medical mistake will leave them comatose and thus incapable of making life-and-death decisions for themselves.

Yet that prospect is what most Americans will now be asked to consider every time they enter a hospital, whether it is to undergo heart bypass surgery or to get a hernia repaired. A new law that goes into effect this week requires all federally funded hospitals, nursing homes and hospices to tell incoming patients of their right to fill out a living will, a document that specifies that if something goes wrong, they will not be kept alive against their wishes. Although the rule is long overdue, experts wonder whether hospitals are up to the bureaucratic task and whether jarring questions--if not properly handled--may stir needless fear and anxiety.

The concept of a living will has been around for decades. Moved by the tragic stories of comatose patients like Nancy Cruzan, the Missouri woman who was kept alive for seven years against her parents' wishes, more than 40 state legislatures have enacted laws aimed at encouraging patients to make their treatment preferences known beforehand. Some of the newest laws authorize people to appoint a surrogate, or proxy, who can make medical decisions for them when necessary. Widespread use of such measures could reduce the extraordinary expense of keeping terminal patients on life-support systems that neither they nor their family desires.

Yet so far, just 15% of Americans have made out living wills, and the new federal rule is an attempt to encourage their use. At Chicago's Rush-Presbyterian-St. Luke's Medical Center the admitting clerk reads a little speech to incoming patients: "Do you have a living will? Can we have a copy of it?" Those who answer no are handed a pamphlet that goes over the Illinois law on the topic. A California health-care group has prepared special booklets describing the basics of living wills in 10 languages, including Chinese and Farsi.

Unfortunately, the law falls short of ensuring that patients will get what they want if and when the critical time comes. Many states allow the withdrawal of treatment or feeding tubes only under limited conditions, regardless of a patient's preferences. Removal may be permitted when death is imminent but not when a patient is suffering from a chronic condition like "persistent vegetative state." Even now, the decision on what is best for a particular patient often winds up in court.

At best, the new law is a mild nudge in the right direction. "It urges people to get their affairs in order," says the American Hospital Association's Fredric Entin. Like many medicines, the measures may at first be hard to swallow, but the consequences of not taking them could be incalculably worse.

By Andrew Purvis. Reported by Lynn Emmerman/Chicago and Jeanne McDowell/Los Angeles.

THE TWO BASIC TYPES OF LIVING WILLS

1. The patient decides whether he wants to prohibit doctors from performing life-prolonging procedures such as tube feeding and artificial respiration.

2. The patient names someone else--a friend, family member or doctor--to make that decision for him. The surrogates can withhold care, hire and fire doctors, and discharge the patient from the hospital or nusing home.