Opinion - Whatcom View

POSTED: Saturday, Sep. 12, 2009

Planning for the end of life is an important task

Public debate over healthcare reform reveals fear and anxiety, perhaps especially over loss of choice when we are frail or nearing the end of life.

The politics of healthcare reform may be debatable, but the inevitability of dying is not. Death comes to us all. However, for those with a life-limiting illness, there are choices as well as the option of safe, compassionate care to assure comfort and dignity in our final days. It's called Hospice.

In this community, Whatcom Hospice serves more than 100 patients every day and cares for about one-third of all local residents at the end of life. Whatcom Hospice, a program of St. Joseph Hospital, admits patients who have a limited life expectancy, a doctor's order for hospice care, and who choose to have care aimed at providing comfort when curing the disease is no longer possible. Most hospice care is given in a private residence, but Whatcom Hospice also serves patients in nursing homes and senior living facilities. A campaign is now underway to build a Hospice House for families who cannot manage these final care needs at home. If community fundraising efforts succeed, Hospice House will open about a year from now. More information is provided at www.whatcomhospicehouse.org.

In the final stages of any illness, when cure may no longer be possible, doctors might suggest treatments with the hope of delaying death. Sometimes the treatment is easy to bear, and other times it can be hard on the patient. The measure of benefit versus burden should be balanced by each patient, based on his or her personal values and goals. Some would want medical care to focus mostly on the comfort and the quality of each remaining day, while others want to try - even against medical odds - to aggressively fight the advances of illness although their remaining life could be consumed with medical procedures or hospitalizations. The point is that choice belongs to each individual.

Before facing a life-threatening illness, each of us has the opportunity and the responsibility to prepare. None of us know if we will be forewarned of our life's end. So if we want to be in charge, we need to make choices now - and make sure that our family, physician and close friends know our choices, so they may honor them. "Five Wishes" is one way to do that. Five Wishes workshops are free and offered monthly in Bellingham.

During the interactive Five Wishes workshop, participants explore ways to direct their own treatment should they become too ill to speak for themselves. A completed Five Wishes booklet is recognized as a legal Advance Directive ("Living Will") in most states. The name "Five Wishes" refers to these important wishes - or instructions - we should each make sure our families and physicians know: the person I want to make healthcare decisions for me when I cannot; the kind of medical treatment I want - or do not want; how comfortable I want to be; how I want others to treat me; and what I want my loved ones to know. Learn more about Five Wishes at www.agingwithdignity.org or phone 756-6895 for local workshop information. The next session is Sept. 16.

Discussing end-of-life care does not reduce one's choices. With an advance care plan documented in "Five Wishes" or a similar form, each person will be more likely to make better informed decisions and to get the kind of care he or she wants.

If you want every last heroic measure tried to extend your life, you can say so. If you have a different vision, you can spell that out. You will be doing your loved ones and yourself a favor if you express those wishes while you are still healthy.

Hospice is not about "giving up hope." Hospice encourages hope by focusing on comfort, dignity and meaningful time with loved ones near the end of life. Personalized hospice support helps patients to live each remaining day of life to the fullest. All of us at Whatcom Hospice feel honored to be able to provide life-affirming care for families as well as patients, and to help with the medical, social, emotional and spiritual concerns that often arise during a life-threatening illness.

Karen Ssebanakitta, RN, MS is director of Hospice, oncology and senior community service for PeaceHealth's Whatcom Region. She is also a volunteer member of the Whatcom End-of-Life Council.

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For more information about advance care planning, you can:

1 Obtain WA State legal forms with explanations in "Who Will Decide?" a free brochure available at any St. Joseph Hospital registration desk.

2. Contact "Aging with Dignity" (1-888-5WISHES or www.agingwithdignity.org) to order a copy of the Five Wishes booklet for $5.00.

3. Visit the WA State Medical Association end-of-life resource page for excellent information and downloadable forms to complete an Advance Directive on your own, at www.wsma.org/patients/endoflife.html