Celebrate new year by putting end-of-life wishes at top of to-do list

The kickoff to the New Year is a good time to put the task of making your end-of-life wishes known at the top of your to-do list.

That's right, the beginning of a new year, with the accompanying reflections on what the future holds, is the perfect time to tell family and friends your health-care preferences in case one day you are unable to speak for yourself. This is called advance care planning and it is good for your peace of mind and for your loved ones, too.

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Studies show people who have conversations about their end-of-life preferences are much more likely to be satisfied with the care received, and their caregivers are less likely to suffer from depression or be left wondering if they made the right decisions for their loved ones.

The reality is many of those nearing the end of life are unable to make decisions for themselves. Yet a recent online poll found that only half of Canadians had discussed their wishes with family or friends — and only 10 per cent had discussed the topic with health-care providers.

Here are four steps to help guide conversations about your advance care plan:

1. Reflect on what makes life meaningful for you.

What do you value most about your physical and mental health? For many people, this includes independence, interacting with family and friends and favourite hobbies.

Now imagine what might make life unacceptable for you.

Modern medicine can and will prolong life in many cases. It can also prolong the end of life, which may require living with severe limitations, such as reduced mental capacity, loss of ability to control bodily functions, lack of mobility and loss of privacy. This is unacceptable to many people; one study found that over half of seriously ill patients in hospital would rather not be kept alive on life support when there is little hope for a meaningful recovery.

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Advance care planning is typically thought about in the context of advanced age or specific diagnoses such as cancer. However, it is important for everybody, and particularly for those with multiple medical problems and frailty.

While frailty increases with age, it can occur at any age and increases the chances of dying. Although catastrophic illness can occur at any time, frailty increases the likelihood that the end of life is nearing, when life-prolonging procedures may not be appropriate or effective.

While many people reaching the end of life say they want to die at home, without an advance care plan, they are often trapped in hospital enduring heroic procedures rather than receiving comfort care during the little time they might have left. Comfort care includes pain and symptom management to prevent or relieve suffering at the end of life.

2. Find out what your care options are and choose a substitute decision-maker.

Learning about care procedures for the end of life will help you make your advance care plan. You can find some common medical and legal terms at advancecareplanning.ca. You can also talk to your doctor.

Many sick or elderly people worry about being a burden on their families. The good news is that patients who have end-of-life conversations place less strain on caregivers and are more likely to receive hospice care or palliative support at home.

Think about and designate a substitute decision-maker. This is someone you trust to make health-care decisions based on your wishes in the event you cannot make them. 

3. Talk about your wishes.

Talk to your substitute decision-maker, your loved ones and your doctor.

Your loved ones will be grateful that you spoke up. Lack of planning has been shown to leave families less satisfied during terminal illness or in the months following death.

There are many ways to get the conversation started and it doesn't have to be grim. The pallimed.org blog recommends humour as a useful strategy. It may take a few tries to get heard, but don't give up.

4. Write it down — just like a will.

Once you have a plan, write it down and make sure everyone knows. In particular, make sure health-care providers and institutions are aware of it and have noted it in your chart. At present, patient preferences are only known in a minority of cases.

Canadians are living longer and healthier. A little planning can ensure the well-being of yourself and your loved ones at the end of life as well.

You've probably already written a will for your things, so why not write an advance care plan for yourself?

John Muscedere is the scientific director and CEO of the Canadian Frailty Network, a not-for-profit organization. He is also a professor in the school of medicine at Queen's University and an intensive care physician at Kingston General Hospital.