Sue Micheletti's parents both died of terminal illnesses, but their passings were dramatically different.

Her mom's last hours were in an emergency room, her life sustained by a respirator at the end of a long, protracted battle endured largely without professional at-home care, while family members argued over whether to let her go.

"One of my sisters freaked out," Micheletti said. "She wasn't ready to do that. So there was a big, ugly scene. It was very traumatic."

Her father died peacefully in Micheletti's home, after extended hospice care, counseling and pain management, surrounded by the people and the possessions he loved. "It was a completely different experience," she said.

The contrast in those end-of-life scenarios fairly sums up the reason for the Contra Costa Conversation Project, a community outreach program that urges people to talk about something too often left unsaid. How do you want to be treated as you near life's end?

Linda Best, former executive director of the East Bay Leadership Council, chairs the project, which is supported by local hospitals, physician groups, hospices and many private and public agencies. Micheletti, chief operating officer for San Ramon Medical Center, is a member of the steering committee and an advocate for advance care planning.

An advance health care directive, as it is known, is how an individual can spell out his or her preferences regarding life-sustaining treatment. How do you feel about feeding tubes? Breathing machines? Pain medication? CPR? Organ transplants?


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Micheletti said surveys show that 70 percent of respondents would prefer their final hours to be a "peaceful passing in their own home in their own surroundings." A much smaller percentage of people actually experience that.

"People should leave this life in the way they desire," she said, "not in a hospital with expensive tests and invasive procedures, if that's not what they want."

The key to making that happen is arriving at thoughtful decisions long before a crisis unfolds. It's detailing personal preferences before an accident or illness leaves a victim unresponsive.

Best said the project's first mission is simply to spread the word. "Most people have never heard about this," she said, "but once you talk to them, they say, 'Oh, yeah, that makes sense.'"

For the time being, the Conversation Project is busy training "champions" and "coaches" who will function as a speakers bureau available for presentations to local community groups. (More information also is available online at www.eastbayacp.org.) The big goal is simply generating awareness of what's at stake.

"The Conversation Project is trying to get people to think about these end-of-life issues before they're faced with them," Micheletti said. "I used to find this a difficult topic to discuss, but after being through the experiences with both of my parents, I fully understand the importance of it."

Don't forget to include your family doctor in your conversations, she added.

"Patients and families need to ask questions of physicians if physicians don't start the conversation first," she said. "They're sometimes reluctant to do that. Old-school docs are trained to do whatever it takes to save lives."

The Conversation Project is designed to let you determine whether that's really what you want.

Contact Tom Barnidge at tbarnidge@bayareanewsgroup.com