None of us of course knows when this will happen. There is a, perhaps surprising, statistic that approximately 25% of all deaths in England and Wales (at least, within the UK) are unexpected or sudden, whether caused by accident, violent assault and so on. That said, the percentage does increase with age. This means that the vast majority of deaths are expected, which gives one the opportunity to prepare.
This is not just in terms of getting one’s affairs in order in general terms, but also in particular spending precious time with those we love. I remember this well in the case of my late Mother who died in May 2010, beginning with her world gradually narrowing down in the final months before the last weeks and days. And, quite simply, she wanted to be with her family close by her at the end.
Dr Kathryn Mannix, whose excellent book Listen – How to Find the Words for Tender Conversations I have referenced in my book, has produced an extraordinarily helpful and indeed comforting four-minute video clip on what actually happens as the body closes down (see on YouTube ‘Dying for Beginners’ by Kathryn Mannix).
It is sensible for everyone, whatever their age and state of health, to make Lasting Powers of Attorney, along with an advance decision (in preference to an advance statement) and perhaps with a ReSPECT form, all as discussed in my book. However, once, whether on account of age or medical condition or both, a life-limiting health condition arises and while mental capacity remains, consider putting down in writing some more specific wishes. This is the point at which ‘curative care’ moves into ‘palliative care’ (the length of which will be uncertain).
On the subject of mental capacity, dementia is currently the leading cause of death in the UK. Its early stages can be hard to determine. To meet the possibility of subsequent legal challenge to the validity of documents signed by the patient, it is advisable for capacity to be assessed by a specialist.
The overall aim of making clear your specific wishes is to help others (both
your medical advisers and your family) to enable you to achieve ‘a good
death’.
This you could do in one of a variety of ways, whatever best suits you. I suggest putting together what is known as an Advance Care Plan, guidance on and examples of which can be found on the websites of a number of charities (Age UK, Macmillan and Marie Curie, among others) and indeed of various NHS authorities. Typically, the Advance Care Plan will detail your wishes on the type of care or treatment you would prefer to receive; the place where you would like to be cared for, so far as possible; and who would be responsible for making any health and any financial decisions on your behalf, which is where the Lasting Powers of Attorney come in. Option A in Section 5 on page 6 of the Health and Welfare LPA gives the Attorney(s) the authority to give or to refuse consent to life-sustaining treatment, which the doctors will respect given that it’s in your best interests – whereas option B does not give such authority.
Then you would confirm where you have set out any legally binding decision to refuse particular medical treatment. As to the place where you would like to be from time to time, this will depend on where you live and may be any of: your home, a care home, a hospice or your local hospital. At a hospice, circumstances would dictate when and whether this might be as an in- patient; or at a day unit; or managed at home; or at an outpatient clinic.
The Plan may be something you choose to put together yourself or in conversation with family members. In any case it is often something to be done in stages rather than all at once.
Separately, perhaps everyone – and not just those who are at risk of heart disease or heart failure – may find it worth thinking about having a specific Do Not Resuscitate (DNR) form made with their GP. This would be kept in an easily accessible place near the front door, if not within a wallet or purse,
so that if the heart stops and the ambulance arrives, production of the form should stop the crew from attempting emergency resuscitation in the case that the individual would not have wanted it.
Finally, if you do have one or more specific medical conditions or are taking medication of any kind, think about completing the Health App on your mobile phone and removing the password, so that if necessary it can be easily accessed by an emergency medical team or doctor.
