Important to consider

personal decisions

You can change your mind. And change it again.

End of life choices and end of life decisions are often complex and ‘subject to change without notice’

Options and choices can change as life changes.

Often decisions need thinking, learning more and then re-thinking. New York Times columnist Jane Brody writes of a retired Judge whose ‘directives became very specific:

Judge Laws said in an interview, he’d want to be ventilated temporarily if he had pneumonia and the procedure kept him alive until antibiotics kicked in and he could breathe well enough on his own. What he would not want is to be on a ventilator indefinitely, or to have his heart restarted if he had a terminal illness or would end up mentally impaired.” Mapping End of Life Choices

Questions to ask of any proceedure, intervention, medication:

Q1 How long will it take me to recover, and what can I expect while recovering?

Q2 When I recover, will I be back to where I was before? 

Q3 What are the possible complications and treatments (repeat Q1)

Q4 What’s likely to happen if I don’t?

What to consider as the body winds down:

We need less and less to eat and drink, as the body functions less and less. Forcing eating or drinking – for fear of ‘starving to death’ – can cause unnecessary complications:

The body can no longer use food or fluids, and providing them may cause fluid retention which makes breathing harder” Dr Michael Gordon, Geriatrician

 Implanted Medical Devices: their purpose changes at life’s end

At life’s end, the very things that keep you alive, may do you harm:Devices that have kept the heart stable – Pacemakers, Implantable defibrillators, implantable cardiac devices (ICD’s) – keep your heart on track through electrical shocks. But at life’s end, these shocks can startle and be very upsetting.

“An implanted device meant to correct heart rhythm may generate repeated painful shocks during a patient’s final hours, at a time when the natural process of dying often affects the heart’s rhythm. Yet, clinicians rarely discuss options for limiting these distressing eventsAmerican Journal of Nursing.

ICDs are not the same as AED’s – Defibrillators – devices that are increasingly available at sports clubs, public transit: they’re meant to save a life in the event of a collapse.

 You may want to read: the ABCs of AEDs

Interesting reading: Hunger and thirst: our needs diminish as life ends