Planning Ahead and End of Life Decisions
Since SARS-CoV-2 (COVID-19) it is very important that we understand your end of life wishes.
Excellent end of life care is extremely important to us and we do our best for all patients at the end of their lives whether they have expressed wishes or not.
It is a prospect some of us prefer not to think about, but we should! We encourage you to plan ahead and decide what you would like to happen if a life-threatening illness or accident should happen or if an illness like dementia should make it impossible for you to manage your own affairs.
Your GP will be glad to discuss the matter with you and inform the relevant agencies to take account of your wishes when the time comes. But before you make any decisions it is important to have this conversation with those nearest and dearest to you so they are aware and understand.
Dying Matters is an organisation which aims to help people talk more openly about dying, death and bereavement, and to make plans for the end of life. Their website has leaflets and advice on having discussions and planning ahead.
Planning for your Future Care is a booklet outlining the choices you might want to consider.
Healthtalk is a website detailing peoples experiences of illness, including dying and bereavement.
1. Advanced Decisions, Advance Statement and Living Wills
A living will is a statement expressing your views on how you would or would not like to be treated if you are unable to make decisions about your treatment yourself in the future.
The term 'living will' doesn't have a legal meaning but usually refers to either an advance decision or an advance statement.
An advance statement can explain your likes and dislikes and include anything that is important for you to be comfortable. It allows you to say how you would like to be looked after and cared for and will be used if you ever lose the ability to make or communicate your own decisions.
Advance statements must be considered by the people providing your treatment when they determine what is in your best interests, but they are not legally bound to follow your wishes.
Advance Decision to Refuse Treatment
An advance decision to refuse treatment (ADRT) allows you to specify what medical treatments you would not want to receive. It is legally binding, as long as it fulfils certain requirements. This means that doctors and other medical professionals must follow it.
An ADRT must indicate exactly what type of treatment you wish to refuse and should give as much detail as necessary about the circumstances under which this refusal would apply.
It will only be used if you lose the capacity to make or communicate decisions about your treatment, e.g. if you have advanced dementia or are unconscious.
The Age UK Website - has useful guidance and factsheets on living wills, advance decisions and advance statements.
Healthtalk - gives a clear synopsis of advance decisions and advance statements.
2. Resuscitation Decisions
Cardiopulmonary resuscitation (CPR) is tried on everyone whose heart and breathing stop, even if there is only the smallest chance or indeed no chance it will work UNLESS the person has made an advanced decision to opt out of CPR. Giving CPR to a patient when there is no chance of revival is both degrading to the patient and a traumatic and demoralising experience to the person giving CPR. If a person is very seriously ill with no hope of recovery or right near the end of their life there is no benefit in trying to revive them.
When CPR is attempted in hospital it is successful in 10 - 15% of cases, of these a smaller proportion will survive long enough to be discharged from hospital. In non-acute areas such as Community Hospitals and public places survival is less than 5%. All of the above figures are dependent on the patients' underlying medical conditions, and illnesses such as cancer and heart disease will reduce the chance of survival further.
Please consider whether or not you would want CPR. This Leaflet gives information to help decide.
If you think you might not want CPR please discuss this with your GP, who will talk it through with you and explain the system to alert emergency health staff of your decision.
We wish to reassure you that if it is decided that CPR won't be attempted this will not affect any other apsect of your care. Your healthcare team will continue to give you the best possible care.
3. Lasting Power of Attorney
A lasting power of attorney (LPA) is a legal document that lets you appoint one or more people to help you make decisions or make decisions on your behalf.
There are two types of LPA:
- Health and Welfare.
Property and Financial Affairs. This gives you more control over what happens to you if, for example, you have an accident or an illness and can't make decisions at the time they need to be made. Useful links The Age UK Website gives useful informtion of LPAs. Mental Capacity Act is a booklet explaining about making decisions about your health, welfare or finances. Who decides when you can't?
4. Organ Donation
Some believe that there is an age limit on becoming an organ donor, but this is a myth. Organs are successfully transplated from people in their 70s and 80s, and the oldest cornea donor recorded was 104 years old. There are very few illnesses that prevent someone from donating their organs after death. The NHS Organ Donation Register explains about how to register your wish to become a donor. Some people choose to donate their bodies, or body parts to medical schools. Human bodies are used to teach studets about the structure of the body and how it works; they may also be used to train surgeons and other healthcare professionals. People decide in advance to donate their body after their death. These donations are highly valued by staff and students at anatomy establishments. The Human Tissue Authority Website gives guidance on donation of your body or body parts for anatomical examination, research, education and training
Grief, although normal, can manifest in a hugh range of unexpected ways. Some people get angry, some people withdraw further into themselves and some people become completely numb. It is not just one feeling, but a whole succession of feelings, which take a while to get through and which can't be hurried.
The Age UK Website
A national charity for the bereaved, providing face-to-face and group support, delivered by trained bereavement support volunteers across the UK. The Ultimate Guide to Grieving Support Resources
Oxfordshire Cruse is a local branch of the national charity.
The NHS Choices Website includes a search engine with a postcode checker to find bereavement services near you.
The Royal College of Phychiatrists Website has a helpful leaflet explaining bereavement.
If you have trouble with bereavement we are very happy to see you to give you advice and support.
Bereavement is the time we spend adjusting to loss. It is a distressing but common experience. There is no standard time limit and there is no right or wrong way to feel during the bereavement period - everyone must learn to cope in their own way.
6. Donating your body to Medical Science
The NHS Choices Website has an article on organ donation.
Transplants are one of the most miraculous achievements of modern medicine, but they depend on the generosity of donors and their families who are willing to make this life-saving or life-enhancing gift to others. One donor can save the life of several people, restore the sight of two others and improve the quality of life of many more.