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This spring, the nation was gripped by the battle over whether Terri Schiavo, a Florida woman with severe brain damage, should have been kept alive by a feeding tube. Schiavo’s husband eventually won a seven-year legal fight to remove the tube, and she died 13 days later. But Schiavo’s case wasn’t unusual, according to several in-house hospital lawyers, who say that they regularly confront similar situations in their jobs. These attorneys explain that their participation in end-of-care cases becomes essential when a dispute occurs. This can happen when there’s a disagreement between the patient’s relatives, as happened in Schiavo’s situation. Other times, medical authorities may debate among themselves about whether life support should be continued. Sometimes the patient’s wishes, as expressed through a living will or a guardian, clash with hospital policy or state law. When any of these conflicts occur, hospital lawyers may be asked to arbitrate between warring parties, to vote on whether to continue a patient’s care, or to represent their institutions in court proceedings. And while the decision to terminate life support is never easy, it’s likely to become even more complicated in the wake of the Schiavo case. That’s because several states are now considering laws that would curtail a hospital’s ability to end a patient’s care. As a result, hospitals may be calling on their in-house attorneys even more often. Sigrid Haines, general counsel for Rockville, Md.-based Shady Grove Adventist Hospital, said she already fields two or three calls a week from hospital administrators, physicians and patients’ families, asking her to intervene in end-of-care disputes. Shady Grove doesn’t require its employees to call a lawyer when a tricky situation comes up, but Haines said, “I’m glad they call me when they do.” In March, for example, physicians at Shady Grove decided that a patient who suffered a brain trauma was “brain dead.” According to Haines, “We wanted to turn off the ventilator because [the patient] took up space in the hospital, and beds are needed for other patients.” The patient’s parents, however, disagreed, and went to court to stop the hospital. At press time Haines was scheduled to appear in court to argue the hospital’s case. “Most people die without an attorney’s involvement,” Haines said. “But that’s not always the case these days.”

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