Mary was a relatively young 80-year-old lady. She always presented for her consultations with an immaculate grey hairdo and red lipstick.
She had been a carer for her husband until a few months prior when he had succumbed to his advanced dementia. Grief was still evident in her eyes and her demeanour although you could see she was making an effort to learn how to live without her beloved Ted. “I catch myself making his favourite meal only to remember he is not with us anymore,” she sighed longingly, “I should celebrate not having to eat meat and three vegetables every teatime but I guess it is something we shared for more than 50 years.” “There is no rush to change things Mary,” I say. “Grief takes as long as it needs and there is no need to try and rush through the process.”
“I am here to discuss making a living will or something rather,” she said. “My daughter has been going on about it since her father’s passing and I thought I would come and ask you about it. I have no idea what it is but she said you would be able to help me. You know Ted never liked talking about death or making plans but I thought I should do this for the family.”
I agreed that getting her to create a living will was an act of love she could do for her family and that I was happy to facilitate the process for her.
“Everyone tends to have a normal will where they outline their wishes about who will have their belongings etc AFTER their passing,” I started my explanation. “Most people however don’t have a living will which discusses their wishes PRIOR to passing on.”
A living will or Advanced Care Directive is a formalised document, completed by a person of sound mind and their doctor, to outline their wishes regarding treatment options should they lose their capacity to make decisions. It facilitates discussions in families about a person’s true values, who they would like to appoint to make decisions on their behalf. For example, would they like to be resuscitated if they were to have a heart attack where the outcome might be poor. It is important to have these discussions before an emergency situation, as family members can become distressed if they have no guidance on what the patient would have preferred.
Mary nodded with understanding before eventually chuckling, “I think this is an excellent idea because I have clearly lived a lot longer than the years ahead of me.”
With the Advanced Care Directive paperwork in hand as well as an understanding on how the process was to be completed, she stood up to end our consultation. She made a follow up appointment to finalise the documents after completing the forms with the family, happy to make decisions about her end-of-life care whilst she still had capacity to do so. “We often cannot predict when death will come, but we can try to prepare ourselves for its inevitability,” I said, acknowledging the privilege of assisting a patient during this milestone.
