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Dying man plans end-of-life with family, state, God

By Jennifer Lee Preyss
Sept. 29, 2010 at 4:29 a.m.
Updated Oct. 1, 2010 at 5:01 a.m.

Roy Smith is facing terminal cancer, but with the last days of his life approaching, Smith has embraced faith to live his last days in peace.

ADVANCE DIRECTIVES FACTSAdvance Directives include living wills, out-of-hospital do-not-resuscitate orders, declaration of mental health treatment and medical power of attorneys.

Texas Hospital Association encourages healthy people to consider their end-of-life wishes, and share them in writing with family members using one of the above methods.

Advance Directives are important because medical technology can prolong life indefinitely, and families and medical professionals can often differ on end-of-life care.

Advance Directives do not need to be notarized, but must be signed and witnessed by two people. They can be revoked at any time.

Advance Directives from other states are recognized in Texas.

More information can be found at www.tha.org or www.texaslivingwill.com.

Leaning over his motorized hospital bed, Roy Smith grabbed Pastor Roger Parrish's hand and began to pray. A few times each week, Parrish visits Smith at home to pray and lend spiritual support to his friend and brother in Christ.

"I know his suffering is more than what most people could bear," said Parrish, lead pastor of Western Hills Baptist Church in Victoria. "Roy has been an inspiration to me, simply to watch him and see his peace."

About seven years ago, Smith was diagnosed with terminal prostate cancer and given a few months to live. While preparing for prostate surgery, doctors uncovered yet another cancer growing in Smith's kidneys. Those diagnoses were second only to his original melanoma cancer diagnosis, discovered in 1985.

Smith is currently receiving at-home care from the Hospice of South Texas, and doctors, are once again, predicting he has only a few more months of life. But he isn't nervously awaiting death. He's well-prepared for his last days, and he's got the Advance Directives to prove it.

Advance Directives are legal documents that define a person's final death wishes. The forms can be prepared at any age and are legally drawn up to direct family and medical professionals about the death wishes of critically and terminally ill patients. Since medical technology today can potentially keep a person alive in a vegetative state indefinitely, Advance Directives indicate whether patients want to receive prolonged care at the end of life or whether they refuse prolonged treatment.

"We've had our wills and all those preparations in place since we were married," Smith's wife, Cindy Smith, said. "All of that has been planned for the longest time."

More recently, the pair discussed and decided to sign an Out-of-Hospital Do-Not-Resuscitate Order, which prevents medical officials from resuscitating Smith if his heart stops beating or he's no longer able to breathe.

"If the doctors came in and resuscitated me, it could break my ribs, or cause some other serious injury, and I decided I didn't want any of that," Smith said. "I've got faith that when it's my time to go, God will take me."

In recent years, Smith's health has progressively declined. The body of a formerly strong construction worker and U.S. Navy veteran has deteriorated to a feeble frame that can no longer walk without assistance. Several of Smith's toes required amputation this year, and his overall weakness often confines him to the bedroom.

Remaining strong in mind and spirit, Smith outlived his doctor's first prognosis in the early 2000s, suggesting the cancer would take his life in a few months. But as the years went on, the cancer has continued to ravage Smith's body, spreading to the lungs, head and bones.

Regardless of medical counsel, Smith's decision to prepare an end-of-life plan was based on the profound reassurance that ultimately life's end is defined by God, not medicine.

"We weren't afraid to talk about the end because God determines the end; he is in control of my life," Smith said.

Now that preparations are in place, Smith's family no longer has any questions about how Smith would prefer to spend his last days. One of Smith's doctors, Ty Meyer, who also serves as medical director at the Hospice of South Texas, said many of the patients he encounters do not consider preparing Advance Directives before a major accident or illness occurs. The lack of planning can cause unnecessary worry and heartache during already stressful times.

"Someone who prepares their wishes beforehand makes it easier on the family at the end," Meyer said. "There can be a lot of second-guessing and worry when those plans are overlooked."

Because religion plays such a major role in death, Meyer said the hospice retains two chaplains, one Protestant, one Catholic, who are available for patients in need of spiritual assistance in their last days.

"I'm certain there are some spiritual issues that play a part in whether someone chooses to prepare for death, or not," Meyer said. "So much of that is sacred, but I'm sure there are some societal reasons as well."

For Smith, however, his decisions about how he would spend his last days were influenced only by a deep resolve that when medicine stops working, it's time to let God take over.

He and Cindy encourage others to consider their own end-of-life plans, and to not discount the importance of Advance Directives.

"It's so important to have open conversations about the end of life, each other's wishes, and respect those wishes," Cindy said.

The security of an end-of-life plan, and knowledge that God is taking care of the rest, allows Smith a fearless exit from the temporal realm.

"Death doesn't scare me; it doesn't bother me. I've lived my life fully and accomplished about 99 percent of what I wanted to do," Smith said. "I'm prepared to die and know it's in the lord's hands now."

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