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End-of-life planning or managing a death properly - Advance Care Directives

Apr 20, 2016

Modern medicine has gone a long way in helping to prolong life but death, at some point, remains inevitable and this is unlikely to change for the foreseeable future.

This prolongation of existence on the planet has had many many societal and personal benefits but has also resulted in an unwillingness to accept that dying is part of life and, hence, many deaths are not ‘planned’ or managed.The mantra ‘we can always do something’ has become paramount without giving thought to the fact that the ‘something’ may cause more harm and detriment to the patient.

It is not easy to predict death as the terminal phase of one’s life can be a slow decline over many years but there are a number of tell-tale signs such as falls, admissions to hospital and a decline in cognitive function.

It is at this point that I think discussions about end-of-life wishes should start.This is clearly important for the patient and those who will provide medical care but it is absolutely crucial for the family and loved-ones.These are difficult discussions and need to take place over time so that all involved understand each others wishes and concerns.

Advance care directives provide an avenue for patients to discuss their wishes about life-sustaining treatments and are a good way to start the process and are relatively simple to enact.

There is ample evidence that those that have had the ‘conversation’ have a much better end-of-life experience - a so-called ‘good death’.The positive effects this has on both patients and their families should not be underestimated.

Atul Gawunde in his book ‘Being Mortal’ explores these issues in detail.It is an easy read despite the subject matter and I would highly recommend it to all those who still consider death as part of life.

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