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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