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Before I die I want to….

Before I die I want to….

22 June 2018

Visitors to our practice over the last few weeks will have noticed a large black poster where the statement was finished with many different “bucket list” items.

They range from Before I die I want to ………live, see the Cowboys win the premiership again, move to Mission beach, see the Southern Lights.

This poster aims to trigger discussion around death and dying. Although most Australian’s have thought about their death very few have discussed their wishes with loved ones.

Many of us are the Enduring Power of Attorney, for our parents or partner but very few of us have discussed with these people what type of life choices they would prefer we made for them. The pressure to make a life changing decision can be overwhelming at the best of times, it is even worse the in event of unexpected accident, or illness.

Palliative Care Queensland helps to make these discussions easier and it campaigns to provide the healthcare and community support necessary for a Good Death when the time comes. This does not involve euthanasia but careful discussion around avoiding futile treatments and providing holistic care in the last phase of our life.

As a GP who has been involved with palliative care and aged care for 13 years now, I can see clearly that the decisions people make in the face of serious illness, change as they go through life. That is why it is important to talk about our wishes as we pass through different milestones, such as parenthood, retiring, moving into nursing care, and even passing 90 years of age!

There are two documents that can help stimulate discussion and make sure our wishes are followed. The Advanced Health Directive (https://www.qld.gov.au/law/legal-mediation-and-justice-of-the-peace/power-of-attorney-and-making-decisions-for-others/advance-health-directive), and the Statement of Choices (https://metrosouth.health.qld.gov.au/acp) can be discussed with your GP. A copy can be kept in your medical record and uploaded to your electronic record (My Health Record).

An Advanced Health Directive allows you to stipulate whether you would like cardiopulmonary resuscitation (CPR), or intensive care treatment such as artificial ventilation (breathing) in certain situations where you are unlikely to recover such as in the final stages of an incurable illness, in a coma, vegetative state, or are so injured you are unlikely to live independently again. It also allows you to specify what you would like in a situation of temporary incapacity. Your GP can advise you how each situation can be approached.

In many of these situations there will be a family member present that doctors can speak to, but what would you like them to say? Another thing to consider is that some people have a close friend, partner or relative they would like medical staff to speak to. Unless you have declared that, doctors are legally required to speak to the legal next of kin, who may or may not be the best person to make your decision.

Making a decision about CPR seems like an easy choice. Studies show that most people, including those over 70s, who choose to have CPR believe that if they are resuscitated they will recover to enjoy the same quality to life. Unfortunately, this is rarely the case.

Cardiopulmonary resuscitation (CPR) has a very low success rate when it occurs outside of a hospital setting, with survival rates as low as 4% in those over 70 years, and almost everyone who is revived using CPR ends up with some form of disability.

Discussing our inevitable death often makes us to think about how we are living, are we spending enough time with family, on personal passions and connecting with nature? Take a moment to consider how you would answer our “bucket list” question.

If you would like to investigate these questions further, consider attending the free Good Life: Good Death Expo at The Ville on the 29 and 30th June.

References- Views on cardiopulmonary resuscitation among older Australians in care: A cross sectional study; Cartilage, Straney, Bray, Mountjoy, Finn; Collegian Journal;  www.collegianjournal.com/article/S1322-7696(17)30079-3/pdf

 

Author – Dr Amy Keys

BSc App ( HMS), MB,BS (Brisbane), FRACGP, ClinDip Pall Care

Amy is a GP who has worked in both Queensland and Western Australia over the last 15 years. She trained in Palliative Care at the Townsville Hospital in 2007 and has an interest in whole of life healthcare.

© Townsville & Suburban Medical Practice, 2018.

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