McEntee: End-of-life conversations with Dad

This is an archived article that was published on in 2009, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Here's how I remember my dad: in a fishing boat, rods out for trolling, at a reservoir high in the Sierra Nevada. And driving through tule fog in the San Joaquin Valley at 4 in the morning during duck hunting season, the cracked window siphoning off his cigarette smoke.

Those days are long past, so here are more recent memories: he has a bad back and chronic obstructive pulmonary disease. He's in a hospital bed, on oxygen, a feeding tube in his belly, his face betraying confusion and anger. He's 84 years old.

He was a combat veteran of World War II, serving on a little tub of a ship that dropped soldiers onto the beach at Normandy. In his final years, he relied on Veterans Administration hospitals for most of his care.

I have his 2007 VA advance directive in front of me; he rejected life-sustaining treatment if unconscious or in a coma; if he had unrelievable pain; and if he were so sick he'd die even with treatment.

All that brings to mind the venomous national argument about "death panels," purportedly composed of health officials who would blithely decide who is to die and who is to live. A child with Down Syndrome? Sorry. An intensive care nurse with breast cancer needs a bone marrow transplant? Too expensive.

It's all fiction, despite Sarah Palin and Utah Attorney General Mark Shurtleff, who's running for the U.S. Senate. He took a shot at Republican incumbent Bob Bennett for applauding President Obama when he said last week that the death panel characterization is "a lie, plain and simple."

Under the proposal Obama discussed, Medicaid would pay for a consultation with health care providers about end-of-life options such as hospice care.

Every family should seek such information. But many of us make our choices as injury or illness befalls us.

An alert man can make his wishes known at one point, then vacillate from hour to hour. And if he's in and out of various hospitals and nursing homes, he must declare his preference at each unless he has a portable document such as Utah offers.

Last winter, my dad had a stroke. As his impairment worsened, he ended up at a community hospital in California, tethered to the tube and oxygen and feeling miserable.

There was a singular event: mindful of his VA advance directive, my siblings and I asked his doctors if they'd ask Dad what his wishes were at that moment.

The attending physician explained to him that if he were about to die, the staff would intubate him and begin CPR. Dad said he wanted that.

Later, his pulmonary specialist made it plain: if he were intubated, he could never be free of it because of prior damage to his esophagus. Chest compressions would break his ribs and he would be in terrible pain for the rest of a very short life.

You can die peacefully and without pain, the doctor said, or you can choose CPR.

My dad chose door two. We siblings exchanged silent looks.

My niece, a physician, talked to our dad later and came away with the sense he was OK with not being resuscitated.

This was no death panel. These were physicians and family members who knew the old man would make his choice -- and change his mind -- as he wished.

Just before dawn on Aug. 23, my dad died in a retirement home. He was unconscious when the attendants started CPR and the EMTs arrived.

I don't know if he'd signed a do-not-resuscitate order there, but according to my niece, it likely wouldn't have mattered. The attendants were doing what they were trained to do.

Dad made his choices and we accepted them. Next June, on his birthday, we'll honor another of his choices and cast his ashes into that reservoir at the top of the Sierra.