DAYTON — When attorney Erica Glass begins her presentation on the importance of written health care directives, she typically begins with a name she knows many people will recognize.

“I always start with Terri Schiavo,” says Glass, a lawyer with Coolidge Wall Co., L.P.A. in Dayton.

“A lot of people know who she was and followed her family’s struggle.”

The highly publicized case pitted the parents and siblings of the 26-year-old St. Petersburg, Fla., woman against her husband, Michael, in a legal battle that lasted for seven years. Eventually, her feeding tube was disconnected and she died March 31, 2005.

“We’re all one car accident, one stroke away from a cognitive disability that might put you in a precarious state,” says Schiavo’s sister, Suzanne Schindler Vitadamo, who will come to town Sunday, June 12, for a concert that will celebrate her sister’s life. “The documents are important. Nobody wants to think about this, but this is happening across our country.”

While most of us may never face such a dramatic life-or-death crisis, we and our families may still be confronted with issues related to disease, illness or injury. The important decision-making process actually begins with something easier said than done: contemplating our own demise and considering what we would or wouldn’t want done in a life-threatening situation. The next step is to make our wishes known to those closest to us as well as our doctors.

“We need to be much more realistic that the inevitable can and will happen to all of us,” says Dr. C. David Joffe, who has been a Dayton interventional cardiologist for the past 35 years. “The young and allegedly healthy don’t think it’s going to happen to them, and the older and sicker expect the doctor or hospital will make them better.”

Every adult, according to Glass, should sign a State of Ohio Health Care Power of Attorney form which officially names the person or persons you would want to make health care decisions for you. In Ohio, that document is available online and takes effect only when you cannot make health care decisions for yourself. If you decide to name more than one person, the two must agree on a particular treatment before doctors can proceed. The 12-page document, which specifies a wide range of potential treatment options, triggers many questions: Do you want comfort care if it will “diminish pain or discomfort” even if it might hasten your death? Are there circumstances under which you would not want to be resuscitated? You’re at liberty to cross out any specific authority in the document that you do not want your health care agent to have.

The choice of that individual is a decision worth careful consideration, says Joffe. It may not necessarily be your oldest child; it may be a child in the medical profession. Religious or other personal beliefs of some family members about death may not be in sync with your own. Be sure and discuss the appointment and the document with the selected individual.

“Many people get cemetery plots and arrange their funerals because they don’t want their children to be burdened, but before that you may be burdening them with unexpected health care decisions,” says Dr. Jules Sherman, senior medical director of Hospice of Dayton.

Sherman, who has worked with the dying and their families for the past 32 years, says it’s not just the families who need to have more conversations about end-of-life issues.

“Doctors need to have them as well, especially when they know their patient is dealing with a life-threatening illness,” he adds, adding that physicians are seeing more patients with Alzheimer’s disease.

“It’s a relentless illness that doesn’t stop and at the end many are extremely demented and lose the desire to eat or can’t swallow,” Sherman explains. He says food may get into the lungs and cause pulmonary failure; if patients have no health agent or Living Will and no family to make a decision for them, they may be placed on a ventilator and remain on life support.

The state of Ohio’s Living Will Declaration, says Glass, states your wishes regarding such artificial life-sustaining treatment. That document, applicable only to individuals in a terminal condition or a permanently unconscious state, works in conjunction with the Health Care Power of Attorney. If there is a discrepancy, the Living Will trumps. Both can be revoked at any time and both require witnesses or notary acknowledgment.

Copies of these documents, advises Glass, should be given to your doctors and your lawyer and kept at home with important papers. You should always bring copies to a health care facility.

When it comes to the most difficult decisions, Joffe believes the key question is this: is there a reasonable expectation that you or your loved one can recover from this illness or accident? And if you recover, will you have some kind of meaningful life?

“Of course, what makes a meaningful life is individual for each of us,” says Joffe. “We’ve made remarkable advances in rehabilitation, so a solider who may have lost a limb can still have a meaningful life. I believe what’s most important is your brain: if your brain works, you’ve got a chance.”

Sherman says there are dramas taking place at hospitals every day dealing with end-of-life care.

“Most of the time these come about because there is a sudden problem like an accident or a complication of an illness that brings patients close to death when it wasn’t expected,” he explains. “A doctor with a good bedside manner can usually discuss the situation with family members and come to a natural decision. But a lot of people find it hard to take a doctor’s advice that further treatment will not reverse the situation.”

Joffe says whenever possible he tries “to take the guilt away” from suffering family members faced with difficult decisions.

“We can’t save everybody and I think it’s the moral thing to do to tell them when things are in such a state that no matter what they eventually decide things will continue to happen,” he says. “We can’t hasten death, but we can try to relieve pain and reassure the family.”

As a 7-year-old child, Katherine L. Cauley lost her 5½-year-old brother to a rare viral infection that resulted in an insufalitic condition, coma and, eventually, death.

“I remember very clearly my mother trying to explain to me about death with the metaphor of a blooming flower — that eventually the flower fades and that some flowers bloom longer than others,” says Cauley, who now teaches medical ethics at Wright State University’s Boonshoft School of Medicine. “This makes sense to me even today. Death is very much a part of life. When people have the courage to think about death and talk about what they do and don’t want at the end of their lives, the end can be less scary and more peaceful regardless of the illness.”