Medical assistance in dying: palliative care

A lot of the discussion of medical assistance in dying has focused on assisted suicide, but there is also the question of trying to die well by avoiding doomed heroic medical procedures at the end. Deborah James, an Englishwoman who chronicled how she dealt with her grim diagnosis, died recently, and is remembered in the British Press.

Here's a story, by a palliative care doc, from the London Sunday Times: 

How to have a ‘good death’ like Deborah James  by Dr Rachel Clarke

"As a palliative care doctor, I’m endlessly astounded by my patients’ capacity to savour their final days with a passion and intensity that can put the rest of us to shame. As time slips through their fingers, people find ways to be incandescent with life.

...

"I often ask patients: “What is the one thing you are most afraid of?” Invariably, the answer isn’t being dead per se, but the imagined horrors of the dying process. A conversation unfolds in which they learn that there are no upper limits on the doses of drugs we can give and that dying is rarely as dreadful as people fear. For the first time, they may start to feel a sense of control over their future.

"Practically speaking, planning ahead gives you the best chance of authoring how your life ends. Deborah, for example, died last week, aged 40, precisely on her terms — at her parents’ house, in the heart of her family, with domestic life quietly unspooling around her — by laying out her wishes clearly.

"Where would you like to be at the end — home, hospital or hospice? Who would you like to be with you when it happens? Sometimes patients regret being swept along by an impersonal medical machine that pushes endless rounds of gruelling treatment. Writing an advance care plan is the best way to ensure that what matters to you is placed centre stage. Appointing a legal power of attorney means that if you lose the capacity to make decisions for yourself, someone else can do so on your behalf.

"Consider asking to be referred to a palliative care team as early as possible. We can help with logistics such as finding carers, equipment, financial advice, “just in case” medications to store at home, and psychological support for adults and children."