It seems to be a bit of a myth, that we handle dying well in Ireland.
While most people profess to preferring to die at home, they have not considered the implications-will they have someone to help them, handle medication, able to do basic nursing? Is their illness complicated? Is the house set up to facilitate easy showering, toilet arrangements and food preparation? Hard questions .
Most people end up having a crisis, going to hospital and then having to conform to the institution's way of doing things...which is not conducive to dying with dignity.
According to the experts in Our Lady's Hospice in Harold's Cross, only 5% of people have made a living will.
This is not an easy thing to draw up and you may need to take advice from family, your solicitor and your doctor. It is difficult to know how you will feel when your time is approaching. Would you like as much as possible done to keep you going? Do you want more treatment? Another operation? These often do make you feel better. Modern medicine performs miracles every day.
Do you want to be resuscitated ?
This sounds easier said than done. The reality is that resuscitation does not always work, despite the many scenes on film andTV.
The difficulty is that hospitals are places that try to keep people alive. Doctors are trained to keep trying. Interesting research shows that medical students have more empathy when they start out than when they qualify. They may override the wishes of the family unless there is a clear, written 'Living will'.
While the Living will is not legally recognised, it is increasingly being given recognition
In this Living Will, it is important to write
D N A R. Do not attempt to resuscitate.
( which always reminds me of a notice outside the main entrance of Shannon Airport,
Do not even think of parking here.) It is gone now.
The changing attitude to faith and belief in the afterlife has also changed people's wishes on how they cope with end of life.
To tell or not to tell is a difficult decision to make.
Most psychologists, doctors and carers consider having the conversation about the end of life to be an important conversation to have. Doctors say that many times the dying person tells the doctor not to tell the family and equally, many family members prefer not to tell the dying person that this is it. Of course, it is difficult to put an exact time frame on end of life. But the general advice now is to have that chat. At least, then people can make informed decisions. In fact, doctors say, that mostly, the person knows.
One of the advantages of going into a hospice is that at this stage, there is an acceptance of the eventual outcome. Unfortunately, due to the shortage of places, getting in to a hospice often only happens at the very end,which is a pity as the wonderful carers-mostly volunteers, take care of the full family and give amazing support.There is an openness .There is no question of further medical intervention and there is a generous approach to pain control. Becoming addicted to pain killers or sleeping tablets is no longer a worry.
The hospice movement facilitate living at home with a system of visiting carers. In fact more people are cared for at home than in the actual hospice, perhaps bringing the person into the hospice at the very end. This is nearly the best of both worlds as it takes the responsibility away from the family members and at this stage, everyone has full confidence in the capacity of the hospice to deal with death in a delicate and appropriate manner.
Besides having the DNAR directive, signed and witnessed, there are other documents and, information that should be put in this folder. Of course, family members need to know where this folder is.
So, what else needs to go in?
Preferred funeral arrangements can be suggested.
For people who are not religious, they may prefer a secular service. There are many templates for these on the internet. Some people have their favourite pieces of music, readings and even suggestions on who should speak.
For those who are religious, it is important to follow their wishes.
Some people even go as far as investigating the costs of coffins, embalming, cremation and funeral plots.
.Notes on bank accounts, savings, title deeds and the last will and testament can be given so that whoever needs to look after the financial affairs can find the various documents easily. These could be left with a solicitor for safe keeping.
The Swedes have instigated a death clean out to be done by the person themselves. This is something we can all start doing. Starting to dispose of unwanted clutter, clothes, half dead plants, furniture. It, according to the Swedes, clears the pathways and brings a calmer, more positive atmosphere. One person told me that when her family went to clear out the house of a recently deceased relative,which they had all been dreading, they discovered that she had done a huge amount of it herself, keeping only a small selection of her favourite clothes. She had given favourite pictures and pieces of jewellery to friends and relatives.
This is a great idea.This way the person knows whether the proposed recipient wants the object. However, when making a will, it is important to name family members, especially children and grandchildren, even if what they receive is small.
It is the thought that counts.
A little forethought can prevent misunderstandings.