BIRTH PLAN? HOW ABOUT DEATH PLAN?
Making a birth plan is relatively easy.
It will often contain directions about what music should be played; when pain relief should be administered; deliery of the placenta and who should be present. (No iPhones, please!) More enlightened mums–to-be will include detailed stipulations about their wishes regarding high-end medical intervention.
However, at the end of the process, if all goes well, there is a new life to celebrate.
Ending your life on your terms. Photograph via Futurity.org.
Making a plan for one’s death is an altogether harder thing. At the end of it… only sorrow and goodbyes.
Would you ever be brave enough to write a plan for your death? Perhaps you should be.
When Pat Jankus, Victorian mum of two, wrote this document she had been diagnosed with terminal cancer.
“My name and address is… I’m of sound mind and understand the importance of this document and request that my stated choices are respected by my doctors and family, now and in the future.
In addition, I request that and all of the above people (listed) pay heed to my beliefs and values in life.
If I reach a point where it is reasonably certain that I will not recover my ability to interact meaningfully with myself, my family and environment – and, as my medical condition is terminal cancer – in the event of having a cardiac or respiratory arrest:
I do not wish to have cardiopulmonary resuscitation initiated; nor do I wish to have artificial means of life support initiated, including intubation, artificial nutrition and hydration.
Antibiotics should be only administered to me to reduce pain and discomfort. Not to prolong life.
Pain care management is my priority.
I trust the relevant medical staff to keep me as pain free, clean and comfortable to the end of life as they are able within the context of my wishes as stated above.”
Now, eight years on and in remission, Pat wouldn’t change a thing.
Although it was very hard to share her wishes for her death with her family, it was a conversation she was determined to have.
“My husband cried,” she remembers. “My eldest son, in his early 40s, said: ‘What a great idea, Mum. This is terrific!’ My youngest son burst into tears. So if they had to make a decision about life support machines etc. I think they would have had a lot of difficulty.”
Professor Bill Silvester is the director of the Respecting Patient Choices program at Austin Hospital in Victoria.
The ethics of when to stop life-prolonging medical treatment and move to palliative care has become his life’s work.
He recalls the day he became convinced that every family should have this talk – no matter how confronting.
“In was in 2001 and I was working in the ICU and we had an fellow who had end stage cancer and he was admitted to the IC unit overnight with pneumonia and he ended up on a ventilator. He was dying and we could see that.
“His wife and daughter came to me with tears in their eyes saying, ‘Why are you doing this to Dad? We could have told you he wouldn’t wanted it if someone had asked’, and it struck me that it was too late to be asking people by that time.
“What we really needed to get better at, as nurses and doctors, was to ask patients, while they were still competent, while they could still think through these things, what they’d want if they were reaching the end of the line.”
And so he pursued the idea of an “Advanced Care Plan”.
It’s an option now available in hospitals and nursing homes throughout Victoria, South Australia and is being taken up in NSW.
Prof. Silvester says that he has surveyed hundreds of people in nursing homes, their friends and families.
“I asked: would you rather go quickly versus having a long, prolonged illness and suffer through that? I am still waiting for someone to put their hand up for the second option,” says Prof. Silvester.
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8 Responses to this article
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Sarah Boggs July 31, 2012
that was such a great article and it was practical thank you so much ,as you say it’s not about euthanasia it’s being practical I know if I become unable to look after myself i would prefer to be let go peaceably. Thank you again
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Debbie July 31, 2012
MY father died recently of Alzheimers. He had left it too late to prepare his own Death Plan (and maybe never would have done, he didn’t want to talk about those things). However, as his condition deteriorated, my sisters and I referred to the concept of an Advanced Care Plan (and found some really useful information online) in advising the nursing home about our expecttions of the level of care and attention we thought appropriate. It was a great relief to be able to access information and advice. After his death, we were left feeling that we had some took control over what took place and that Dad was treated well and was able to die peacefully in the bed that had been his for some time, rather than moved to a hospital and his life sustained when all hope (and joy) was gone.
Mind you – I can’t get my 90 year old mother to complete an Advanced Care Directive. I think its best to do it when the end perhaps doesn’t seem quite so imminent.
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Benison O'Reilly July 31, 2012
This sounds like a wonderful initiative. We are living this as we speak with my father-in-law, who is gravely ill in hospital.
Fortunately, after some tense weeks the whole family is now in agreement that there will be no heroics. He is a wonderful man but any chance of him having an independent future has gone and he wouldn’t want to live like that. -
The Huntress July 31, 2012
Advanced Care Directives are incredibly important. It’s heartbreaking as a nurse to watch families try to make decisions that would be in the best interest of their loved one, but unable to come to a decision or agree amongst themselves. I have seen some occasions whereby families do choose to undertake extraordinary medical interventions to prolong the life (or extend the dying, as I feel it often is) of their loved one, solely because they either can’t let go (the decision is too painful at such an emotional time) or they don’t know what their loved one would have wanted and by requesting active treatment they at least feel they did everything they could.
If we could take a deep breath and have these difficult discussions it would save so much pain and heartache on behalf of families and make the jobs of healthcare staff much, much easier. Knowing that you have helped someone to have a ‘good death’ is a wonderful thing. It’s an important time of our lives and knowing we’ve done the right thing by the people we love offers peace and dignity to us all.
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WENDY GREEN August 1, 2012
I am 55 years old and I have chosen to have ‘No medical intervention’ to prolong life if I suffer any medical illness or accident. Pain relief is okay – I am no mater. I am not afraid to die. Why is everyone so afraid to die? Death should be considered a natural part of life and comes when our time is up – pure and simple. It’s the medicos and people who can’t bear to endure the pain of separation from loved ones that keep people alive long after their ‘use by date’.
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Elaine August 1, 2012
Thank you so much for reminding me to do this. Great information.
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Annie from Faulco August 6, 2012
My wonderful late husband made his wishes totally clear.
His choices were underpinned by his own values and informed by realistic advice from his lovely specialist doctor, augmented by the experiences of wise, compassionate community and hospital nurses who answered his direct questions with equally direct answers. He knew what to expect.
After many hospital admissions, during all of which he unexpectedly “turned the corner”, he left our home in an ambulance for the last time.
When treatment failed, he chose to withdraw medication and accept to die comfortably. He spent his last days planning his non-funeral with me, and entertaining many visitors.
On the last day of his life, there was such hilarity in his room that the nurses frequently asked us to keep the noise down. He told death jokes, matched by better ones from his friends.
He was happy, loved and then lapsed into a coma a few hours after his last visitor. My daughter and I were able to sleep on sofabeds in his room during his final days. All of this in our local public hospital, where he was known to the staff as an appreciative larrikin, and the whole experience was in accordance with his wishes.
He was lucky that we all knew, and respected, his wishes. No tubes, no ventilators, no machines beeping.
He reckoned that it was a good way to die. I agree.
His Life-Celebration was the perfect combination of respect and his insistence on speakers taking the piss and making people laugh. It worked. His musical choices were as idiosyncratic as the man himself.
He planned his death and a party for his friends. My grief is assuaged by the knowledge that he died without pain, and that his non-funeral/Life Celebration is remembered with a chuckle by many in my community.
