Decisions to consider when beginning the end-of-life discussion

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SALT LAKE CITY — Death is a somber subject to tackle, and there are several challenges surrounding decision making for end-of-life care.

Gov. Gary Herbert asked all of us to face our own mortality Friday. He signed a joint resolution encouraging all Utahns to sign an advance directive so that if the time comes when you can't make decisions for yourself, your family will know what to do.

The Wunderly family is just one family facing some of those difficult choices now.

"I'd say there are hundreds of people in the Salt Lake Valley at this moment going through the same thing you are," Dr. Michael Galindo told Nodia Wunderly during a recent patient consultation.

Nodia Wunderly's 94-year-old mother, Beth, suffers from a long list of ailments, including dementia. She was in the hospital recently because she fell. Her family also just found out she has ovarian cancer.

With the help of Dr. Galindo, a palliative care medical director for Intermountain Healthcare, they discussed how aggressively they wanted to treat Beth's cancer.

"(Palliative care) focuses on dignity and connections with people that we love, and people that we want to be with in our lives," Galindo explained, "and it focuses on communication and understanding what a disease process is about."

Galindo spends a lot of time making sure there is a clear line of communication between the patient, the family and the health care team.

The tools have gotten to be so complicated, but they don't really address the human need. They don't really address some of the basic interpersonal needs, and that really is what palliative medicine is all about.

–Dr. Michael Galindo, palliative care medical director

"The tools have gotten to be so complicated, but they don't really address the human need," he said. "They don't really address some of the basic interpersonal needs, and that really is what palliative medicine is all about."

Laura Voorhees has made her end-of-life care decisions known to her family and her doctors through an advance directive.

"I do not want drastic anything that will prolong my life," Voorhees said. "(Don't) put me on a feeding tube so I can't communicate, be part of life. I have no desire for that."

Voorhees has a terminal chronic airway obstruction. She started receiving hospice care last April, and that includes home visits from her doctor. She says the service has given her hope and peace.

"I don't fear death," Voorhees said. "It's a natural thing you are going to do, and it doesn't frighten me to die and to talk freely about it." That candor, and her planning, has been a gift to her family.

"It eases the burden," said daughter Sharon Packer. "Our job is to see that her wishes are carried out, and that's really freeing."

Voorhees does not plan to spend the rest of her life dying; rather she lives each day to the fullest of her capacity.

"Patients by day, peace when the night falls, God's touch when I pray," she said.

Approximately 25 percent of all deaths in the United States now occur in a long-term care setting. Studies have shown that patients who receive nursing care at home have a better quality of life and fewer hospital re-admissions, which significantly reduces Medicare costs.

More importantly, it gives people more freedom to choose how they die.

"To see it done well, and to see it made comfortable and dignified with lots of loved ones around; it's a very heartwarming thing," Galindo said.

As for Beth Wunderly, she's now receiving hospice care in her daughter's home and her family says she is doing better. They hope to celebrate her 95th birthday in April.