Best to plan for death while still full of life

23:37, Nov 26 2012

How do you want to die? For some, ensuring that they live well is important and often time consuming, but how many of us think about dying well?

What does that even mean? Much of the answer will depend on what death you have experienced. The long, slow, painful death of a beloved parent, the tragic accident that took one too soon or the one we often read in the death column, "He died doing what he loved - fishing, tramping, golf " or "in her sleep".

Some of these departures would have been expected, some are not. Would they have been a better death if they had been planned for - a few instructions for those who are nearest and dearest - "the next of kin". For those who have walked in those shoes, these are times when a conversation or a directive from the person dying would have been very useful.

Carrying out someone's wishes would provide relief in what are often trying circumstances.

But we are so busy living life that we don't dwell on the end game. Is that out of fear of dying or fear of the way we will die? For those around us, I think it would be great to have a conversation about this. As a society, we need to have a discussion about dying.

In today's medical jargon, there is talk of advanced care plans.


The name implies that we think about how we want our last days to be. Where will they be spent, who will be there, do we want the medics to fill us with chemicals, whisk us off for more tests and more surgery if it's available. Must we try everything? Or do we want to be kept pain-free and comfortable?

I appreciate that the answers will vary for specific situations, but what do you want? We should have these conversations when we are well and living life to the full.

Once diagnosed with a condition or having had a medical event or accident, we become all consumed by the unfamiliar situation and reliant on the professionals around us. If you have already thought about some of these questions, you will be more able to participate and work with them.

We hear much about euthanasia - people choosing to end their life when they want to go or, as my Pocket Oxford describes it: "The gentle and easy death; bringing about of this, especially in case of incurable and painful disease".

This is a different discussion from the one I am suggesting, but for some situations, my discussion would be useful and perhaps lessen the anguish for loved ones.

How we die is often a choice taken from our hands, but if you could be in control to the last breath, how do you want that last breath to be? Write your thoughts down, discuss it with your "next of kin" or maybe your GP.

A word of caution - if you have more than one "next of kin" - ie, more than two adult children or friends - tell them your plan.

We have all heard about the one sibling who doesn't know the plan and prevents these wishes from being carried out. The best made plans of mice and men . . .

Of course, all of this is fine for the journey we plan for. Some will never get that luxury of time, but for those who will and for those who will share the journey with us, let's take a bit of time to write it down and let those close to us know what we want. Like planning for an overseas holiday, often the planning is fun. After looking at all the options, you decide what you really want to do.

The other positive about planning is that once it's done, you are more prepared and maybe some of the fear around dying may ease. That's a really worthwhile reason to start the conversation.

There are many cultures we could learn from in which people "die well". We are getting better at celebrating life when someone has gone, but we could do better if we started to talk and write down what's important to us, before it's needed.

Jenny Black is chair of the Nelson Marlborough District Health Board.