Wednesday, June 4, 2014

Valuable lessons on death and dying

I've seen a whole lot more than my fair share of death and dying;  first in South Africa, during military and civilian life during eighteen years of pretty much non-stop civil unrest and terrorist violence, and then as a pastor under rather less violent circumstances, ministering to the dying and their families at home and in hospital.  The theology and internalization of the process of dying is going to vary from person to person, depending on their faith (if any) and their personality, level of maturity, and willingness to face reality.  (Some don't want to face it at all, demanding a miracle from the doctors, their family, their pastor and God, and blaming them all when they don't get it.)

However, there are intensely practical aspects of preparing for death that we all need to think about irrespective of our world view.  They involve 'getting all our ducks in a row', making sure we've taken care of the paperwork and other arrangements that will make life easier for those who outlive us.  The latter also have their own work to do to prepare for the hole we'll leave in their lives when we're gone.  Two articles over the past few days offer useful advice.

The first is from the Telegraph.  Here are a few of the author's suggestions.

1. Draw up a plan. Just as you would draw up a birthing plan, creating one for the other end of life is also a useful exercise. What is really important to you? Where do you want to be looked after? What is the next best alternative? Do you want lots of medications, or do you want to be as meds-free as possible? What other measures do you want taken? Who do you want to be there?

As with a birthing plan, this is only a guideline, and may well go out of the window. But to have it as a starting point is useful for the patient, their loved ones, and the medical team. Sometimes doctors struggle to stop treating patients and allow them to get on with dying, so it’s helpful if you can give a steer on when enough is enough.

Drawing up such a plan is, of course, not easy. Most people struggle, because to do so means to admit, to themselves and to others, the reality of their situation. It means looking death in the eye, and many people, especially and understandably the young, find this extremely difficult to do. If you feel strongly, write it down.

2. Tie up loose ends. While you are able to, you need to look after any situations that will upset you if you fail to do so. You don’t want to be spending your last days regretting your inaction, whether it’s to do with domestic stuff or personal matters. If you want to reconcile with someone with whom you have fallen out, pick up the phone. I often see people reconciling with estranged loved ones at the very, very end of their life, and I often have heard 'l wish l‘d done this sooner'.

If a relationship is so important that you need to reconcile in your last days, surely it was worth salvaging weeks, months or even years before, when there was still time to enjoy it.

There's more at the link.

The second article is from Marketwatch.  Here's an excerpt.

As a rule, financial, legal and medical experts will tell you there are four documents that everyone — not just your parents, but everyone — should have in place in preparation for death: a will, a power of attorney, a living will and a health care proxy. The will obviously dictates how you want your money and other valuables divvied after death. The power of attorney allows an “agent” (i.e. a son or daughter) to manage your affairs, financial and otherwise. And the living will and health care proxy deal with how you want your medical needs handled and who can speak on your behalf in the event of your incapacity. It will cost your parents some money to pull all this together, but I saved quite a bit by enrolling my folks into a prepaid legal program that carried an annual fee of a couple hundred dollars. The service directed me to a local attorney who did all the paperwork, with no extra charges beyond the annual fee I already paid. (A couple of caveats: I’ve had mixed experiences using the prepaid program for other legal matters. And I should make it clear that my parents had a very simple will.)

Again, more at the link.

I encourage you to read both articles, then examine your own preparedness for sudden or unexpected illness or death.  It can happen to any of us at any time.  If you haven't thought about the very practical steps discussed in both articles, now would be a very good time to start doing something about them.  If the worst should happen, believe me, your surviving spouse and/or children and/or other close companions will be grateful you did.



Peter B said...

A health care proxy may not be adequate for people with serious illnesses. In such cases a POLST (Physician's Orders for Life Sustaining Treatment) should probably be in place, at least in the USA. Different states may use slightly different names.

It's standing orders from your physician on how to manage medical treatment in an emergency when you are incapacitated. Advance directives will apply once you're hospitalized, but in some cases you may not want certain levels of treatment started by the first responders.

In California, the POLST is a red form kept on the refrigerator door; the first responders are trained to look for it.

Here's how describes it:

The National POLST Paradigm is an approach to end-of-life planning that emphasizes patients’ wishes about the care they receive. The POLST Paradigm – which stands for Physician Orders for Life Sustaining Treatment – is an approach to end-of-life planning emphasizing: (i) advance care planning conversations between patients, health care professionals and loved ones; (ii) shared decision-making between a patient and his/her health care professional about the care the patient would like to receive at the end of his/her life; and (iii) ensuring patient wishes are honored. As a result of these conversations, patient wishes may be documented in a POLST form, which translates the shared decisions into actionable medical orders. The POLST form assures patients that health care professionals will provide only the care that patients themselves wish to receive, and decreases the frequency of medical errors.
POLST is not for everyone. Only patients with serious illness or frailty should have a POLST form. For these patients, their current health status indicates the need for standing medical orders. For healthy patients, an Advance Directive is an appropriate tool for making future end-of-life care wishes known to loved ones.

Anonymous said...

Thank you for your post / repost topic. I definitely agree with your making plans for your passing and reconciling with people who you had issues with. Time heals most wounds and 'talking it out' with the other brings you and the other peace. Taking that 1st step is hard, but its worth it.

Old NFO said...

Yep, already done. As a retired military guy, that's pretty much a stock requirement.