Advance Planning
Information about planning for end of life
There is much recent evidence which shows that people who have planned in advance for the end of their life spend less time in hospital, receive fewer intensive treatments and have a greater quality of life when they reach their final days.
In addition, those surviving the person who has died experience less stress, anxiety and depression.
We may think and worry about the consequences of becoming seriously ill, disabled, ageing, and what will happen to us at the end of life. Advance Planning is the process of enabling us to think about this and express wishes about how we would want to live our lives until the very end.
Planning in advance can help guide others to make the best decisions on our behalf should we be no longer able to speak or decide for ourselves.
We all know we are going to die but we don’t know when.
What many of us want (and unfortunately do not always get) is to do our dying as we would wish.
This means choice and control of our own destiny; where our dignity, physical and emotional comfort is of paramount importance, where we can die with grace and at peace.
If we have made our wishes and choices known in advance, about what we would like when the time comes, then we are much more likely to get what we want.
This can include the place we want to die; the people we want around; the care, physical, emotional and spiritual comfort we’d like to receive; invasive medical procedures we may want to refuse; choosing a person(s) who will speak on our behalf if we can’t; whether or not we would want to donate our organs or our body; how we would like our funeral to be and so on.
Not only can we have more choice and control over our dying but we can also relieve the people we love of the burden of having to make decisions.
As a Doula, we can support the person and those they love to express and write down what they would want.
For us it is about opening up the conversation so there is trust, honesty to gain true insights into what is important to the person and then capturing this in written form, sometimes supported by a video.
We can cover some or all of the following but what is important that the plan is a true reflection of what the person wants.
What you want
Where you would prefer to die?
How do you want to be cared for?
Food/drink/books/films/music?
Who do you want around you?
What treatments do you want and not want
Would you prefer a natural death with the minimum of medical interventions?
Would you want to be resuscitated?
Who do you want to speak for you
A spokesperson to make decisions if you can’t speak for yourself – dementia, stroke
An attorney under a Lasting Power of Attorney for Health and Welfare
After Death
Your will
Your online presence
Your funeral
Organ Donation
Glossary of terms
An Advance Decision (also known as an Advance Decision to Refuse Treatment and as an Advance Directive in Scotland) is a document in which you set out your end-of-life choices. It allows you to write down any medical treatments and interventions that you don’t want to have in the future, in case you later become unable to make or communicate decisions for yourself. You can write down your refusals in advance and for when you are no longer communicate, and are unlikely to regain the ability to do so,
e.g. if you have a brain injury, a stroke, or in the late stages of dementia. You may not want CPR, a ventilator or a feeding tube at end of life and you can refuse these treatments now. Advance Decisions are legally-binding, provided they are properly completed.
An Advance Statement is a written statement that sets down your preferences, wishes, beliefs and values regarding your future care. An advance statement lets everyone involved in your care know about your wishes, feelings and preferences if you are not able to tell them. An Advance Statement is not legally binding but should be taken into consideration by healthcare professionals. It often accompanies an Advance Decision to give a richer picture of who you are.
Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) – the purpose of a DNACPR decision is to provide immediate guidance to those present (mostly healthcare professionals) on the best action to take (or not take) should the person suffer cardiac arrest or die suddenly.
Lasting Power of Attorney – is a legal document which allows you to give another person the legal authority to make healthcare and/or financial decisions on your behalf. The person you appoint is called an Attorney and should be someone you know and trust. In England & Wales there are two different types of Lasting Power of Attorney:
Health and Welfare Lasting Power of Attorney
Property and Financial Affairs Lasting Power of Attorney
Mental Capacity means being able to make your own decisions. Someone lacking capacity (because of an illness or disability such as a mental health problem, dementia or a learning disability) cannot do one or more of the following four things:
Understand information given to them about a particular decision
Retain that information long enough to be able to make the decision
Weigh up the information available to make the decision
Communicate their decision
Useful Resources
Forms and guidance
Compassion in Dying: https://compassionindying.org.uk/
Completing your Advance Decision to Refuse Treatment
Advance Decision Assistance: https://adassistance.org.uk/
Lasting Power of Attorney
https://www.gov.uk/government/publications/make-a-lasting-power-of-attorney