Making the big decisions – the truly important ones

Have you thought about end-of-life planning? Dr Erica Cameron-Taylor tells why you must.

Don’t put off the big decisions

Choosing benchtops is one of those decisions many people struggle with. Real stone or composite? The colours are great in the composites, but will granite add more value? Or will a red wine spill be a disaster? Is the snob value worth it? Scrubbed wood, or perhaps channel Gordon Ramsey and go for brushed steel? It’s a big decision.

According to a recent poll that I conducted with my long-suffering patients, people spent an average of nine hours considering their choice of benchtop. Choosing a cordless drill took my (mainly male) patients, on average, an hour and a half; a barbecue longer at three hours. Choosing new bed linen hit a middle zone of four hours. There’s often a bit of a look on day one, some advice from a friend and a check of the catalogues in a café before the final decision is made.

By contrast, the same people spent an average of 15 minutes making decisions about end-of-life care for themselves or someone they loved. Fifteen minutes. And that was the average. Some spent as little as five. No one wants to think about that stuff. But everyone wants their decisions respected. It’s like tax. Not thinking about it won’t make it go away.

End-of-life care plans, formalised as ‘advanced care directives’, encompass not just the well-known issue of CPR or resuscitation, but such things as whether the patient will be admitted to the intensive care unit, whether a machine will be used to help them breathe, whether artificial feeding will be offered, blood transfusions, or antibiotics through a vein. This is big stuff. Much bigger than kettle versus built-in, Ryobi versus Makita.

And we know that these decisions are often made at the worst possible time. Things aren’t going well, the treatment isn’t working, she’s not breathing easily, the heart is failing, his cancer is progressing fast. Often over-worked junior doctors complete the paperwork at the bedside, sometimes even more junior nurses tick off a cheat sheet in the retirement village. So it’s hardly surprising that advanced-care planning, so beloved of government and hospital administrators alike, has proven itself not nearly as useful as everyone hoped.

But this article isn’t about end-of-life planning. It’s about planning for end-of-life planning. If you put some thoughts in place while you are well and capable, things will go a lot more smoothly. The care that you, or your loved one, receives should be as close as possible to the care that you want. Leaving everything to a rushed five minutes at the bedside is a recipe for disaster.

So, five quick things to do some time in the months or years before that fateful day that will come to us all sometime, somewhere.

  • Decide who will speak for you if you can’t. Your son? Your friend? The publican? I’ve seen the latter more than once. And remember, this person isn’t the one who ‘should’ do it. It’s the one who you feel in your heart of hearts really understands what you want.
  • Tell the people close to you what you want and who you’ve decided will speak on your behalf, if necessary. I’ve seen too many daughters insisting mum wanted to be assisted by a ventilator when it’s pretty clear, if you listen to mum’s best friend, that she wanted no such thing.
  • Don’t avoid going to a lawyer and formalising your power of attorney and enduring guardianship issues if you need to. Memory failing? Health falling apart? Idiot son planning to steal all your assets? Do it now.
  • Have a think about the reality of the human condition. You’re not going to live forever. Deities excepted, none of us do. Going to bed in fine health at the age of 92 and waking up dead is ideal. But not everyone gets that. Accept the frailty of age and the ravages of illness, if they come, with grace and dignity. Don’t give up – but don’t hide from truth either. Doctors are not required to offer futile treatments. Not everything can be fixed.
  • And the final point? Well, that one’s easy: live the very best life you can. Go for the sparkly pink Caesar-stone, the hammer drill with brushless tech or the 800-thread count Egyptian cotton in teal if that’s what you want and can afford. Why the hell not?

Dr Erica Cameron-Taylor is a GP and palliative care specialist. She has a private practice in New South Wales with a focus on supportive oncology. She adds: “I have a husband who plays the bagpipes, two almost adult children and too many animals.”

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    COMMENTS

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    *Loloften*
    31st Jul 2018
    11:29pm
    Great advice, felt calmer after did both Enduring & Medical POAs few yrs ago (both kids only for both) + Will still relevant from decades ago (also both kids, or their kids if their Dads' "passed"). Also ensured I don't want to be resuscitated if on life support/prognosis not good. Equally importantly as per chats with adult children, insisted on a private cremation in a cardboard box (hope that's possible/if not, cheapest wooden box available) + no fan-fare apart from a few happy drinks/music @ the closest pub for family & friends who want to turn up. Done & dusted...altho' not ready to "go" just yet!!


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