The News Observer (Raleigh, N.C)

RALEIGH, N.C. – With Thursday’s announcement that her breast cancer has returned, Elizabeth Edwards, wife of former U.S. Sen. John Edwards, must decide how to spend her days, or years, wisely.

Such evaluations are common among people who receive a life-threatening diagnosis. People who face a similar prognosis say those decisions are intensely personal and challenging.

As of this week, Edwards has already made one decision: to fight her disease amid her husband’s presidential campaign. Cancer survivors said they respected it.

“The point is, cancer is not a death sentence,” said Ambrose Dudley, 67 of Raleigh, who was diagnosed with bone cancer 10 years ago. “You just have to live life.”

Dudley, a retired Associated Press reporter whose cancer returned last summer, said he watched Thursday’s news conference in which the Edwardses explained Elizabeth’s condition and the couple’s decision to continue campaigning, and found himself cheering.

“I said go on. Go.”

Those who study end-of-life care say there are no prescriptions for how to live out one’s days. Patients make decisions that are as different as their personalities.

“Practical wisdom requires a reading of yourself and what you’re able to take on,” said William May, a medical ethicist and theologian at the University of Virginia’s Institute for Practical Ethics and Public Life.

May said there were two kinds of courage for people in this situation: the courage of attack, which requires a willingness to fight the disease, and later, the courage of endurance, which comes when medical options run out.

And he suggested Edwards may have both. She has already proved she has the courage to fight her cancer, first diagnosed in 2004, but she has also learned the courage of endurance in dealing with the death of her son, Wade, in a car accident in 1996.

One thing seemed certain Friday – public perceptions of the Edwardses decision would continue to be hotly debated along political lines.

“She’s a very independent woman,” said Tomma Hargraves, 58, who was diagnosed with lung cancer in November after feeling a lump in her neck. “Each of us is different. It’s a very personal decision, and I don’t think any of us – unless we’ve been through something similar – has the right to judge.”

Indeed, just about the only advice experts on end-of-life care had to give Elizabeth Edwards was the obvious: form a community of support for the challenging times that lie ahead, and talk to loved ones about what makes life meaningful. Those kinds of conversations may be particularly helpful in making decisions as the days grow short.

And they pointed out, while Edwards may be forced to confront her mortality now, everyone must eventually face up to it. In the words of The Psalmist “Teach us to number our days aright, that we may gain a heart of wisdom.”

For some that wisdom may mean a recommitment to family, for others it may be travel or a dedication to causes they hold dear. In Edwards case it may be the conviction that her husband is best suited to lead the country and that fighting for issues he has championed – eliminating poverty, providing affordable health care – is how she wants to be remembered.

“What would she do if she went home?” asked Julie White, 33, of Raleigh who was diagnosed with breast cancer around the same time as Elizabeth Edwards. “I remember, I went home, and you start to think and your mind wanders and it’s horrible.”

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(Staff writers Kristin Collins and Dan Kane contributed to this report.)

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(c) 2007, The News & Observer (Raleigh, N.C.).

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AP-NY-03-23-07 2034EDT