Medical advances are helping severely brain-damaged and comatose patients prolong their lives through various means, such as breathing, feeding, and hydration tubes. Some people place great value on planning ahead for such situations and making important decisions before they are no longer able to do so. With the recent attention paid to the Terri Schiavo case, the issue of making a living will is on all of our minds.

A living will, a type of advance directive, is a legal document detailing the type of medical interventions you do and do not want to receive in the event that you are incapacitated at the time they need to be made. This spares your loved ones from being forced to make tough decisions for you, and it gives you a say in your medical treatment when you can no longer speak for yourself. Living wills should be frequently updated; your feelings about your life and medical care change, and what you want for yourself today might not be what you’d want for yourself in 15 or 20 years.

Another kind of advance directive is the durable power of attorney for health-care decisions, or the health-care proxy. With a durable power of attorney, you choose a person over age 18 whom you trust to make your medical decisions for you when you can’t do so for yourself. This person becomes your health-care agent, or proxy, and his or her decision takes effect as soon as you lose the ability to make your own. He or she has no legal obligations and is not responsible for the financial costs associated with treatment.

Advance-directive forms are relatively easy to fill out. Some are even available online. Nonetheless, many Latinas still don’t have one. Studies have shown that fewer Hispanics complete living wills than people of other ethnic backgrounds.

So why aren’t Latinas getting around to writing their living wills? Distrust for doctors and lack of affordable health insurance may scare some away. They may fear that if their living wills state that they don’t want to be kept alive by machines, doctors may not do enough for them.

“I don't have one,” says Mayna Nevarez, president and founder of Nevarez Communications, “but I've been giving it some serious thought after the Terri Schiavo case and the death of my uncle this past November. Even though he was a lawyer and had helped several people with their living wills, he didn't have one! I don't think that people should be afraid of writing one at all.”

Orianna Morales, a broker from Ft. Lauderdale, Fla., adds her two cents: “We tend to think that we're invulnerable, and we don’t want to worry about things like a power of attorney. We also tend to think that the surviving spouse, and/or children, will automatically take on the burden. [The] problem with that thinking is that they may not be able to do so, or even have the resources.”

A living will can be important because verbally expressing your feelings to your spouse or loved ones may not be enough. Gabriella M. Edwards-Holguin, president of the Mexican American Bar Association of El Paso, warns: “Even if you verbally expressed your wishes to one of your loved ones, it may be something that at that moment the loved one simply can not deal with—or perhaps they disagree with your wishes and want something other than what you verbally expressed. Worse yet, what if you have parents and a spouse fighting over what ‘you would want’?”

For some married Latinas, the issue is more about their spouse’s future. “It's easier for me to say that I'm for it [living wills], because I really believe that it relieves the burden on my husband and my family to determine what decision needs to be made about me. I don't want to use up my insurance money, or taxpayer money, or take up a hospital bed just because I didn't make it clear what I wanted beforehand. I love my husband enough to know that his happiness is important after I'm gone,” says Claudia Phillips, COO of Hispanic Digital Network.

Latinas are generally a proud breed, and they might never even think of the possibility of not being able to make decisions for themselves. If they do think about one day being in a comatose state, they might have strong feelings about whether or not they’d like to be kept alive by machines. “Absolutely not,” says Jackie Arredondo, a professional singer and a vocal coach for Emilio Estefan’s new reality show Voces de America. “I would hate to be a burden on my family, and I’d like to be remembered healthy and well. Not as a vegetable on a hospital bed.” She goes on to say that she would draw the line at a year. “If they say that it’s highly unlikely that my condition will improve, then its best to let me rest in peace”.

Kelly Rogel, an accountant from New Jersey, echoes the same feelings: “I would not want to be kept alive if there is no way I can communicate. If there is no hope for me to ever be able to communicate, I would want to be taken off the machines.” Kelly plans to write her living will in about two years, as soon as she buys her home.

For other Latinas, religion plays a strong role. Assessing and attending to a patients' spiritual needs can be just as important as attending to their physical needs in end-of-life care.

The Rev. Luis Cortés Jr., president of Esperanza USA, says, “As clergy, we would like to hold onto life as long as possible, since we believe it to be a gift from God. I am hopeful that as a nation we learn of the importance of having a living will and the significance of clearly expressing our wishes with those we love. A vague decision can and will almost always lead to painful soul-searching and decision-making by guardians or worse—courts and the legal systems”.

Before making an advance directive, it’s important to understand your options. This is true both for living wills and for the selection of a health-care proxy.

Edwards-Holguin recommends: “First and foremost the person you pick for a durable power of attorney for health care should be someone you trust, and someone you think can carry out difficult decisions on your behalf.” Her first recommendation is your spouse. “He is usually the person who will feel the most affected by an event that may call for the power of attorney to be invoked,” Edwards-Holguin says, “since presumably you are on good terms and have the day-to-day contact. He can best make decisions for you and your family especially if there are minor children.”

Unmarried, divorced, or widowed Latinas might turn next to a parent or sibling. “These are people who have known you all your life and will want to help honor your wishes and keep your best interest at heart,” says Edwards-Holguin.

In some cases, Latinas might want to look outside of their families. For example, says Edwards-Holguin, “sometimes it is harder for parents to hold the power of attorney, because they brought you into this world and they tend to want to keep you in it, no matter what.”

In any case, when choosing a health-care proxy, it is important to weight all the factors. “You need to be the judge of the various characters of the above suggested people,” says Edwards-Holguin. “If you know your Mom believes in using all means to keep someone alive and you don't want to be hooked up to machines, clearly you don't want her making your health care decisions for you.”

Everyone must make her own decisions about end-of-life care, and Edwards-Holguin recommends thinking ahead. “I look at it as taking care of business and standing up for yourself by leaving your wishes documented in a way that will ensure your voice is heard even when you are unable to speak.”