FOWLER - Last summer, doctors approached Tom McDonald about creating a living will.
Tom, a 67-year-old General Motors retiree from Fowler, had developed an infection following arthroscopic knee surgery. The infection was not considered life threatening, but Tom's first inclination when drawing up his living will was to refuse life-support if, God forbid, anything happened.
His wife, Judy, balked at the idea.
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After learning in October he had terminal liver cancer, Tom McDonald, 67, of Fowler, signed a living will stating he did not want to be resuscitated or kept alive artificially. His wife Judy, center, and daughter Michelle Smith, right, have helped with his care. He entered the Hospice of the Valley program after Christmas.
"I said, 'Why?' - because he was healthy other than that," recalled Judy, 67, a retired florist.
Tom took her advice.
But in October, the McDonalds received devastating news. Tom was diagnosed with liver cancer, and at his age, little could be done. Doctors said he had less than six months to live.
Given his bleak prognosis, Tom decided he did not want to spend his last months shackled to life support machines and feeding tubes. He updated his living will to reflect his original wishes, permitting only pain medicine to keep him comfortable, and had a do-not-resuscitate order put in place.
This time, Judy did not argue.
Just after Christmas, the McDonalds contacted Hospice of the Valley so Tom could live out his final days as comfortably as possible.
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Discussing end-of-life care with doctors and loved ones can be a very difficult and uncomfortable conversation, but experts say these discussions are much easier if they take place long before a terminal diagnosis.
"So many times, families wait until a crisis occurs," said Lisa Solley, chief of community relations, wellness and training at the Area Agency on Aging 11. "That's not the time to be making decisions."
Those decisions, also known as "advance directives," include creating a living will and a health care power of attorney. According to the Ohio State Bar Association:
n A living will is a legal document that prescribes which types of life-sustaining medical attention a person would want if he or she were to become terminally ill or permanently unconscious and no longer able to communicate his or her wishes. A patient can decide, for instance, that he doesn't want CPR performed or feeding tubes inserted.
n A health care power of attorney is a legal document that permits another person to make medical decisions for the patient if the patient is unable to communicate his or her wishes. Specific wishes can be spelled out in the document, and the person appointed must follow the patient's wishes. Unlike a living will, the patient need not be terminally ill or permanently unconscious for a health care power of attorney to apply.
In the U.S. House of Representatives version of the health care reform bill passed in November, there is a provision that would allow doctors to be reimbursed through Medicare for end-of-life counseling, including discussions with senior citizens about living wills, health care powers of attorney and end-of-life services, including hospice care. The bill was later amended to clarify that patients would not be forced to receive such counseling.
The Senate version of the health care reform bill passed in December has no end-of-life counseling provision.
Congress must merge the two bills into one before it can be signed into law by the president.
Though the provision in the House bill would apply only to seniors, experts say people of all ages should consider end-of-life options.
"Every person should have advance directives because you never know when it's going to be the last day," Solley said. "Tragedy happens every day. You can't say, 'Oh, I'm gonna, I'm gonna.'"
Jane Peachey, a bereavement counselor with Hospice of the Valley, said the advance directives conversation should begin with a physician who can fully explain various life-sustaining medical procedures. Religious beliefs also should be considered, as many religions have different stances on end-of-life care. And families play a vital role, because they are the ones who must ensure a person's wishes are fulfilled.
"I want to be sure they are comfortable making decisions for me," said Peachey, who has had her own advance directives in place for years. "Are you comfortable saying, 'No, don't put her on life support.' If you think that's going to burden you, I'll go find someone else to represent my wishes."
Advance directives also help relieve the burden put on family members when a loved one is near death, Peachey said. It can be very difficult for a wife to deny life-sustaining treatment to her terminally ill husband. But if the advance directives are clearly spelled out, the wife can have the peace of mind in knowing she's acting according to her husband's wishes.
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Last week, Tom McDonald lay in his bed at his Fowler home, covered in a blanket made by his daughter with the words "Papa Tom" stitched into it. On the wall, just above his bed, was a photo of his prized 1936 Ford truck.
Sitting in her dimly lit dining room, Judy said Tom had "gone downhill" in the previous few days.
"His mind has gotten real confused," she said, because of his pain medication and sedatives.
The night before, Tom had fallen out of bed, and Judy couldn't get him back up. She had to call the fire department to help her. After the firefighters got Tom back into bed, they gave her a big hug.
Judy said she is able to cope because she has faith that someday she'll be reunited with Tom and their son Robbie, who was killed 25 years ago in a three-wheeler accident.
But despite Tom's decision to forego life-sustaining treatment, Judy said she has not made advance directives for herself.
She understands Tom's desire for quality of life instead of treatment that would make him "sicker than sick" with little guarantee of recovery. But, Judy said, "We lost our son when he was 15, and I would have had them try anything."
She summed up her position: "I think each case is different."