ELLSWORTH – Don’t wait until you or your loved ones are old or sick; start talking now about your end-of-life wishes. And don’t stop there. Create a legal document that’s as simple or as detailed as you like, have it witnessed and notarized, and keep it where it can be found.

That was the take-home message for about 80 hospice workers and others interested in end-of-life issues who gathered at the Unitarian Universalist Church in Ellsworth on Wednesday to learn about providing appropriate care to the dying. The daylong conference, titled “Ethical Dilemmas at the End of Life,” was hosted by Hospice of Hancock County.

Morning presenters at the conference came from the local area and included an attorney, social workers, an area resident who described how she coped with the death of a beloved brother, a physician and a chaplain. In the afternoon, the group was linked electronically to the Hospice Foundation of America’s 12th annual Living With Grief Teleconference.

The event drew energy and interest from the recent publicity over the case of Terri Schiavo, the brain-damaged Florida woman who died on March 31 after a prolonged political debate over whether her tube feedings should be discontinued.

Barbara Clark, director of Hospice of Hancock County, said the high-profile Schiavo case has given rise to healthy conversations in many families and fueled interest in advance directives, medical powers of attorney, and other legal means of controlling the care one is given at the end of life.

“I think there are two things people want to have in place when they’re dying,” Clark said. “They want to know they will be loved and cared for, and they want some sense of control over what’s happening.”

That sense of control, and a host of other benefits, are best achieved by deciding in advance what one’s wishes are and making sure those wishes are known, conference attendees were told.

Attorney Jeffrey Jones, who specializes in estate planning, said most people should have both an advance directive and a durable power of attorney for health and personal care. An advance directive allows individuals to make their own decisions about feeding tubes, ventilators and other life-prolonging measures ahead of time, while they are able to communicate their intentions clearly. Power of attorney appoints some other trusted person – usually a spouse, parent or adult child – to act on behalf of another in a broader set of circumstances, such as admitting them to a long-term care facility, giving consent for specific medical treatments, having access to medical records and other actions.

In the absence of such legally binding documents, Jones said, Maine law permits the primary physician to take guidance from an appropriate family member. But in that case, the law determines who is chosen to represent the patient’s best interests, and the patient has no say, Jones cautioned.

Jones told the audience that since the Schiavo case assumed national prominence, almost all of his estate-planning clients have raised the issue of end-of-life care.

“Most of them tell me they do not want to have their lives artificially prolonged if there’s no hope for recovery,” he said.

Social worker Linda Morin said much family conflict is avoided when legal documents clearly spell out a dying person’s wishes or designate an agent to make decisions. Rather than arguing over thorny legal and medical care decisions, she said, families can spend precious time more productively.

Family physician Susan Ostertag discussed the notion of “medical futility.” Sometimes the possible benefit to a patient is outweighed by the burden a treatment imposes if there is no meaningful quality of life or hope for improvement, she said. For example, tube feedings may prolong life, “if by ‘life’ you mean the heart is beating, the lungs are exchanging gases and the blood is circulating.” Withdrawing medically futile treatments, she said, “does not cause the death. It allows the death to occur due to the underlying condition.”

Hospice chaplain Allen Myers cautioned that the end of life is not always the “peaceful slipping away” most people desire. Advance directives and other legal preparations may allow patients to maintain a sense of control, but there’s no way to ensure “the good death,” and those left behind may be burdened with a sense of guilt that they didn’t manage better, he said. Like childbirth, Myers said, the process of dying is natural, unpredictable and resistant to control.

“Each of us must decide for ourselves [the end-of-life care we wish to receive], and as this conference makes clear, many of us must also decide for others,” he said.

Many health care institutions have forms that can be downloaded from their Web sites. These forms must be witnessed, and in some cases notarized, in order for them to be legally binding. Copies should be given to family members, the primary care physician and other trusted individuals.