Young, healthy and preparing for the worst

Sara Lohrman isn't waiting for her doctor's nudging to complete her health care directive. This proactive senior spelled out her end-of-life wishes months ago.

Directives are in the news this week, as critics of health care reform have stirred up the whopper that Granny will be forced to drop her knitting needles and submit to creepy "government-encouraged euthanasia." The part of the story that should scare us silly is how few Americans have a health care directive.

So it's with admiration, mixed with humility, that I introduce you to Lohrman -- a senior, all right, at William Mitchell College of Law in St. Paul. She's 24 years old and perfectly healthy.

"It's for my family," Lohrman said of the multipage document she completed in April, "to make it easier on them."

Her law professor, Kim Dayton, who directs the Center for Elder Justice and Policy, calls Lohrman "pretty unusual." But Dayton points out that the three most wrenching national stories around end-of-life issues have involved women in their 20s: Terri Schiavo, Karen Ann Quinlan and Nancy Cruzan.

Dayton has colleagues at other law schools who require students to write a heath care directive, also called an advance directive, before passing the class. She isn't going that far, but she's heartened that even "appallingly misleading" information of late may spawn a more level-headed discussion within homes and doctors' offices across the country. While the number of Americans with health care directives is reported at around 25 percent, Dayton thinks it's more likely in the single digits.

Aside from House Republican leader John Boehner of Ohio's government-encouraged euthanasia claim, other tracts circulating include myths such as, "Government will provide an approved list of end-of-life resources," and "The government has a say in how your life ends."

The truth? Under the plan, Medicare will pay for a 30-minute session with a doctor every five years, if the person wants to talk about end-of-life decisions. Operative word: If. This addition is important because it gives doctors, who are typically queasy about broaching the subject of dying, a way to incorporate it as one more topic along a continuum of health issues.

"People don't have to check in with anybody," Dayton said. "They have every right to say what they want and don't want. You can use a health care directive to express your wish to go on living no matter what."

But allowing the medical community a billing code for this type of session, she said, "increases the likelihood that people will have these documents when they need them."

It's the highly unusual family who won't need them. While a will is also a good idea, it spells out only what happens to property and assets when one dies and does not involve health-care decisions. A "living will" is also something else, limited to cases of terminal illness and no longer valid in Minnesota.

Health care directives do the heavy emotional and physical lifting, tackling one's spiritual beliefs and values, and views on pain control, prolonging of treatments, organ donation, burial and more. Without such detailed guidance, families members are often left agonizing, fighting in court or plain perplexed.

"I said, 'Whoa, I didn't expect that,'" said Lohrman, 54, of Wilmar. "I would have made completely opposite decisions if she hadn't written it. It's her life. Her beliefs."

Sara's mom, Julie, found the whole thing "hard." But it's growing on her.

"Sara is a planner. She thinks ahead," said Julie. 52. "I'm not surprised at all that she chose to do this."

Lohrman said she'll review her directive after five or 10 years. "I feel like I'll have the same ideals then, but you never know," she said.

For now, it's filed away and she's doing just what the doctor ordered: Enjoying life. She plays on the Hennepin County Bar Association softball league, walks the lakes, attends sports events and plays fantasy football, "when I'm not studying." She plans to graduate next spring.

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"I don't imagine it's because they don't want to," she said, kindly. "It's just because they haven't gotten around to it."