Tuesday, 1 June 2021

For those nearing the end of life's journey - the making of a Living Will

Most of us will die in hospital in old age - but the final days need not be out of your hands. In a powerful new book, consultant in geriatrics DR DAVID JARRETT, who has witnessed 3,000 deaths, reveals how you can go gently into that good night


 Doctors' strategies for their own decline

I have cared for dozens of medical colleagues at the end of their lives.

At first, I was apprehensive, thinking that I must always be on my best behaviour and discuss the full range of possible investigations and treatments. But the actual attitude of these patients was completely different.

A lifetime of clinical practice ensures there is no rose-tinted view of what can be achieved. They were rarely in favour of resuscitation and plans for ongoing treatment included clear advice on when they did not want me and my team to intervene. These instructions would often be set out in a living will.

  • A living will (or advance directive) is a plan drawn up outlining what someone wants to be done, or, more likely, not to be done, if they become ill and unable to decide this for themselves.
  • My own living will specifies: ‘If I am unable to swallow I do not want intravenous, nasogastric or other methods of feeding and hydration.’
  • You can also make something called a living statement (or an advanced statement or statement of wishes), which can be a helpful guide to care staff, especially in cases of prolonged dementia and frailty.
  • It details how you would like to live your life if you lose your mental capacity — what you like to eat, drink and wear, what type of care you would prefer, and so on. (The default option in nursing homes tends to be sweet tea and soap operas. You have been warned.)
  • My own living statement includes: ‘I would like to remain in my own home for as long as is possible. I do not take sugar in tea or coffee. I have always enjoyed the grain and the grape and would like this to continue until I die, whatever the medical advice to the contrary.’
  • Both are legal documents —although you do not necessarily need a lawyer to put them together.
  • Both need to be signed to be valid, and a living will also needs to be signed by a witness. Give copies to your family and to anyone who could be involved in your medical care, including your GP.

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