What a boring but necessary task I have embarked upon! As I am moving to Sri Lanka for a year I began a very long and tedious list of what must be put in place. I like lists and best of all I like crossing things off them.
I had the obvious chores listed; arrange BPAY for council rates, electricity, car insurance, house insurance and changing the mailing address for letters that slip through and need attention.
Medical checks were put in place, vaccinations, a skin cancer check, chest x-ray, mammogram, blood tests and a general check-up. I also attended to minor repairs around the house and cleared out clothes for charity. I especially won’t need winter clothes in Sri Lanka so that was a good starting point to clear space in what my husband refers to as ‘Joy’s Boutique’.
I was feeling pretty pleased with myself and my list was shrinking when I read an article in The Sydney Morning Herald’ with the awe striking title ‘The day I meet you in the emergency department will probably be one of the worst of your life.’ The article was written by Dr Ashleigh Witt and she ran through a scenario she often witnesses when relatives have to make decisions on the dying wishes of their loved one.
Until I spoke with Ash and read her excellent piece I believed I was totally covered for all medical emergencies. But not so. My will is up to date. My solicitor has a copy and my children know I don’t want to linger and suffer without hope. Ash has allowed me to quote her in this article. She begins with ‘My name is Ash and I’m the medical registrar on duty. I’ll be your Mum’s doctor tonight. Mum is very sick. Please sit down so we can talk about what is happening.’
If you are organised you will have in place an Advanced Care Plan and this will remove all the stress of decision making and also the possible differences of opinion between relatives.
Ash explains that if someone is 21 they do all in their power to save the person however, if the patient is 101 it is very cruel and better to focus on comfort. However, if medical intervention is called for doctors must follow the instruction. For example if CPR is needed to restart a heart it will break ribs. To keep a patient alive, tubes can be used, machines will breathe for the patient, kidneys can be filtered to remove toxins and patients can be attached to life support. These procedures in the frail are often not successful.
When an elderly person’s heart stops CPR will continue for minutes or hours but doctors know when it is discontinued the person will die. Ash says ‘it’s not a good or dignified death but as doctors we must proceed if that is your wish’.
Some people say they want everything done. But when they know what this means they come to realise they don’t want anything done at all. The second option is called comfort care and this allows patients to be with families and to die with dignity. The intervention option often means pain, medical staff and dying without loved ones at the bedside.
It is to be expected that death in elderly frail people is natural. We know we won’t live forever and organising a ‘Good Death’ is one of the most important tasks of our lives. In fact it is really part of a good life even though it is saying goodbye.
Your wishes can be taken care of by filling out an advanced care plan, giving copies to your GP and family. You can then live a relaxed life knowing there will be no burden on others to make very difficult decisions or becoming a victim of painful procedures which are against your wishes.
Many countries will have different requirements but you can google websites for Advanced Care Planning.
If you want to have an ‘Enduring Guardian’ you will need to legally appoint a substitute decision maker under the Guardianship Act 1987. This must be in the approved form.
With an ‘Advance Care Directive’ you need to provide specific information relating to your wishes, values, and any treatments you would not want to receive. This can be on a form, or in some other way, e.g. a letter. Supported under common law.
In NSW Australia: http://advancecareplanning.org.au/resources/new-south-wales
The original article was written for The Sydney Morning Herald by Dr Ashleigh Witt, a doctor training to be a geriatrician. Her final line was ‘please have this talk this week, regardless of whether your parents are 60 or 100. Your future self will thank you for it’.
I have taken this one step further and rather than chat it out with family I will fill in the forms and make sure they are in the right place for a time which hopefully will be decades down the track. Whilst this may seem ghoulish, at the completion of the procedure I felt a great deal of satisfaction in knowing my kids won’t meet a doctor in emergency and have to make difficult decisions.
My thanks go to Dr Ashleigh Witt for sharing this story with us.