Palliative Care - Getting ready for a good death

Palliative care at any stage focuses on the comfort of the person who has a life-limiting condition. Comfort can mean:

• pain is managed;
• an environment that is pleasant and personalised;
• people around that provide love and reassurance; and
• spiritual and emotional needs are acknowledged as well as physical needs.

While death is inevitable to all of us it is something we avoid thinking about and planning for. So:

• How can we plan for a good death?
• What things would we want to settle?
• What decision can we make before our death to ease the burden on those left behind?

The effect of not having conversations about dying may mean that we end up dying in a way that we would not have wished. For example, I may feel ready to die today, but am kept alive in an intensive-care unit for a week instead.

Planning a good death might involve:

• Psychological preparation includes talking about an impending death with caregivers, family members, and others;
• Controlling pain and discomfort;
• Having a will, trust, or other arrangement that sets out who gets property and how it should be divided;
• Specifying final medical care in an advance directive e.g. do not resuscitate order;
• Making final arrangements for body burial or cremation;
• Indicating preferences for a funeral or memorial service.

Most people see our health system focused almost exclusively on curing illness and prolonging life, rather than on improving the quality of life, relieving suffering and providing comfort.  Most people say they would prefer to die at home. However three-quarters of the population dies in some sort of medical institution, many of them after spending time in an intensive care unit.

Being in control
To be proactive, many elderly are choosing not to have life-prolonging treatments and instead to have comfort or palliative care in their own home through hospice and family support. Choosing to die at home may mean that both the elderly person and their children or close associates with enduring powers of attorney have clarified their attitude towards death, choices they can make, and when it is appropriate to make these choices. Without the input of the elderly person in these decisions children are more likely to wish to prolong life longer that the elderly person may wish. 
Willie Molloy says in his book, Let Me Decide, "If we have stated our wishes clearly, doctors and family don't have to second-guess what kind of treatment we would want.” In this manner you take your family "off the hook" and give them some peace of mind.

Palliative Care Support
If you find the whole idea of discussing death, Elder Family Matters can access counselors who can help you. Ring us on 0800 321 789. If you live in the wider Wellington region (including Wellington city, Hutt Valley, Kapiti coast, Wairarapa, Porirua basin) and you want Palliative Care support in your home then call Elder Family Matters Ltd on 0800 321 789 or email on efm@elderfamilymatters.co.nz