Never say die

Dying got so protracted and difficult it became necessary to invent the living will — a list of opt-ins and opt-outs during the last days/weeks/months. If you haven’t made one, you know you should. 

What a living will does not record, because it doesn’t need to, is something we also all need to decide for ourselves, preferably as far in advance as possible. It is: what will we do if the prognosis is terminal, but we are offered chemotherapy?

It’ll mean balancing side-effects against time bought. It’ll mean a very down-to-earth discussion with the doctor. And it’ll be vitally important that we don’t kid ourselves, the side-effects may not be worth it. 

Most people, according to this article, do kid themselves. In a survey, over 1,100 patients with a recent diagnosis of stage IV lung or colon cancer who had opted to receive chemotherapy were asked what their expectations of their treatment were. 69% of patients with lung cancer and 81% of colon cancer patients reckoned that a cure was “very likely,” “somewhat likely” or “a little likely”. 

In other words, they misunderstood why they were receiving chemotherapy. And they’re all dead. 

Doctors know that people can be unrealistically optimistic in the face of an insuperable tumour. There’s this idiotic notion that cancer is a test of character, it can be defeated by willpower (and only losers surrender, presumably). Yes, we can easily delude ourselves. 

The survey also reveals that patients who awarded their doctors best scores for communication were the ones with the most wildly optimistic expectations of their chemotherapy. 

End of Life Planning Makes a Difficult Situation Much Easier

Posted by Colin Moore

One of the toughest challenges anyone can face in their lifetime is losing a loved one and then having to guess what kind of funeral and memorial service they would have wanted, also to try to locate important documents and find the answers to key questions.  But it does not have to be this way, by documenting our preferences and important details in advance of need, families can be spared making the difficult decisions of what to do next and avoid all of this uncertainty.

End of Life Planning is about thinking, discussing, planning and documenting the final event in our lives before it actually happens.  It should be a big part and a necessary part of any estate or financial planning service.  We cannot control how we die, but we can control how our finances will be managed, how our estate will be distributed, the sort of funeral we would like and what arrangements or messages we would like to leave behind for our families.

The worst time to plan a funeral is when someone has died.  You only have an average of twenty-four to seventy-two hours to make all the arrangements, while also dealing with the emotional impact of the loss of a loved one.  So, making difficult decisions which cannot be undone when you are overcome with grief is not the best time.

Making an End of Life Plan allows you to make extremely important decisions through a calm and clear thought-out process. In other words, it is much more likely that you will make more rational and logical decisions. This helps to ensure your funeral wishes and other family matters can be arranged in a more meaningful way, and the way you would have wanted.

Most people don’t know how to begin planning for life’s ending.  But for everyone who has made a Will they have already taken a step in the right direction towards pre-planning their future  wishes.  The problem is, this form of planning alone fails to address their family’s immediate concerns between the time of death and and in the crucial days thereafter leading up to the funeral when major financial decisions have to be made.   

The key to effective end-of-life planning is not to race through filling out legal documents but to take the time to understand the full scope of what is involved in putting our entire affairs in order and to seek out solid information on each topical area.  Then we can fully embrace the whole process.

Although an End of Life Plan will not completely alleviate the emotional and financial pressures people will face, it will certainly help them reduce or eliminate many of the most stressful decisions, pressures, and expenses, and ultimately help ease the pain of a very difficult situation.

Colin Moore is founder of The Funeral Consultancy and regularly provides courses and seminars on Caring for The Bereaved and End of Life Planning.

ED’S NOTE: We are huge admirers of Colin here at the GFG. Goodness knows how much money his work has cost him (we know how it feels, Colin!). He is motivated entirely by a desire to be useful and helpful. Do check out his website. He has been tenacious and he has persevered. At long last his work is gaining official recognition in Leicestershire and, what’s more, financial backing from Big Society coffers. Colin, we salute you.  

Ready, steady, gone.

“Most of us do not want to die in the ICU tethered to tubes — not the quality of life we expect. Yet only 30 percent of us have made arrangements to prevent this from happening. Death and dying is a tough subject for us to broach. Be aware that very few of us will die in our sleep — most have a slow sometimes excruciating decline to death.

“I bet you didn’t know that less than one in seven CPR recipients live to leave the hospital (don’t feel bad, many doctors don’t know this). Other studies show that few elderly patients or patients with cancer live to leave the hospital after CPR. Despite the fact that CPR was developed to resuscitate patients in cardiac arrest, CPR is mandatory to rescue the terminally and critically ill, unless there is an advanced DNR directive. One in five people die in intensive care with the last few months of life being expensive, painful, and futile exercises in medical care.”


ADRTs — who does and who doesn’t

From a letter in the New York Times:

Older adults who do not formally convey their treatment preferences to loved ones create a distressing situation in which children and spouses must make emotionally draining (and costly) decisions about whether to continue or stop life-extending treatment.

As Ms. Jacoby points out, one obstacle to planning is a reluctance to discuss and confront one’s own demise. Yet my research, based on interviews with more than 7,500 Americans, points to another important obstacle: money. Many people complete their advance directives as part of their estate planning; the living will is written up along with one’s will and other documents to protect one’s assets.

But many people with few financial assets to protect do not take the important first step that often kicks off the advance care planning process. People in the lowest quartile of assets are only half as likely as those at the top of the assets ladder to have a living will, to appoint a health care proxy or to discuss their treatment preferences with loved ones.