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Doctors remind people to plan for end of their lives

 | Published on Saturday, April 23, 2011

"Life is a terminal disease."

The one-liner from Dr. Jeremy Blanchard elicited chuckles from the 100 or so people who attended a Columbia Basin Badger Club forum Friday about end-of-life decisions, but beneath the laughter lurked a somber truth -- everyone dies.

But Blanchard and fellow panelists Drs. Stephen Iacoboni and Wayne Kohan said there are ways we can prepare ourselves for the eventuality of our own deaths, whether they come in the form of a lingering illness such as cancer or a sudden event such as a heart attack or a car accident.

Blanchard is the medical director of Kadlec Regional Medical Center's adult hospitalist and intensivist programs, and said he most often sees the latter kind of patient -- people for whom a sudden event leaves them in intensive care and with tough decisions to be made by their families about whether to continue medical care or to let go.

But people can ease the difficulties faced by their loved ones by having an advanced directive stating what kind of medical care they want.

"Really, advanced directives are the beginning of a conversation," Blanchard said.

He said too many people don't have these conversations with their families, and the families are left guessing when the worst happens.

"My challenge to you is to ask yourself what gives you joy and dignity in your life," Blanchard told the audience. "Define what is an acceptable quality of life. Then have the guts and love to share it with your family."

Iacoboni, who leads the oncology program at Kennewick General Hospital, said he sees death from a different angle than Blanchard.

"We often don't use advanced directives in oncology because the person is going to die anyway," he said. "Families have time to talk about it."

What can be difficult for terminal cancer patients is coming to terms with the fact of their deaths and what -- if anything -- happens afterward.

Iacoboni said patients who embrace spirituality and a belief in some kind of afterlife tend to come to their deaths more peacefully than those who do not.

He said he believes a culture of atheism in the United States does terminally ill patients a disservice by taking away the possibility of an afterlife, thereby adding anxiety and uncertainty to the process of dying.

"Traditional beliefs are under assault, or at least under question in a way that hadn't happened in the history of the human race," Iacoboni said. "That has an effect for the dying."

It's a dilemma he explored in his recent book The Undying Soul, which collects stories from his years as an oncologist.

"This isn't so hard if you drop dead on a tennis court or get hit by a car, but it is hard for a cancer patient," he said.

Like Blanchard, Kohan emphasized the importance of making decisions about the quality of life desired, and then having a durable power of attorney giving a trusted person the authority to enforce those decisions for people who no longer can speak for themselves because of accident or illness.

But he said communication is important so the person granted power of attorney knows what decisions to make.

"It's important if you have power of attorney that you're doing what they want and not what you want," said Kohan, who is a family practitioner and assistant medical director for Hospice at the Chaplaincy.

"The only way they can do that for you is to tell them what you want," he said.



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