When Planning Is a Matter of Life and Death

Barring medical marvels as yet unrevealed, we are all going to die. We try to keep ourselves and our loved ones in good health, but it’s important to be prepared for the eventuality of death.

While this is not a cheerful topic, considering these things in advance can help us manage a very difficult thing, when the time comes.

We’ve put this under “Psychology Sunday” as it pertains to processing our own mortality, and managing our own experiences and the subsequent grief that our death may invoke in our loved ones.

We’ll also be looking at some of the medical considerations around end-of-life care, though.

Organizational considerations

It’s generally considered good to make preparations in advance. Write (or update) a Will, tie up any loose ends, decide on funerary preferences, perhaps even make arrangements with pre-funding. Life insurance, something difficult to get at a good rate towards the likely end of one’s life, is better sorted out sooner rather than later, too.

Beyond bureaucracy

What’s important to you, to have done before you die? It could be a bucket list, or it could just be to finish writing that book. It could be to heal a family rift, or to tell someone how you feel.

It could be more general, less concrete: perhaps to spend more time with your family, or to engage more with a spiritual practice that’s important to you.

Perhaps you want to do what you can to offset the grief of those you’ll leave behind; to make sure there are happy memories, or to make any requests of how they might remember you.

Lest this latter seem selfish: after a loved one dies, those who are left behind are often given to wonder: what would they have wanted? If you tell them now, they’ll know, and can be comforted and reassured by that.

This could range from “bright colors at my funeral, please” to “you have my blessing to remarry if you want to” to “I will now tell you the secret recipe for my famous bouillabaisse, for you to pass down in turn”.

End-of-life care

Increasingly few people die at home.

• Sometimes it will be a matter of fighting tooth-and-nail to beat a said-to-be-terminal illness, and thus expiring in hospital after a long battle.
• Sometimes it will be a matter of gradually winding down in a nursing home, receiving medical support to the end.
• Sometimes, on the other hand, people will prefer to return home, and do so.

Whatever your preferences, planning for them in advance is sensible—especially as money may be a factor later.

Not to go too much back to bureaucracy, but you might also want to consider a Living Will, to be enacted in the case that cognitive decline means you cannot advocate for yourself later.

Laws vary from place to place, so you’ll want to discuss this with a lawyer, but to give an idea of the kinds of things to consider:

National Institute on Aging: Preparing A Living Will

Palliative care

Palliative care is a subcategory of end-of-life care, and is what occurs when no further attempts are made to extend life, and instead, the only remaining goal is to reduce suffering.

In the case of some diseases including cancer, this may mean coming off treatments that have unpleasant side-effects, and retaining—or commencing—pain-relief treatments that may, as a side-effect, shorten life.

Euthanasia

Legality of euthanasia varies from place to place, and in some times and places, palliative care itself has been considered a form of “passive euthanasia”, that is to say, not taking an active step to end life, but abstaining from a treatment that prolongs it.

Clearer forms of passive euthanasia include stopping taking a medication without which one categorically will die, or turning off a life support machine.

Active euthanasia, taking a positive action to end life, is legal in some places and the means varies, but an overdose of barbiturates is an example; one goes to sleep and does not wake up.

It’s not the only method, though; options include benzodiazepines, and opioids, amongst others:

Efficacy and safety of drugs used for assisted dying

Unspoken euthanasia

An important thing to be aware of (whatever your views on euthanasia) is the principle of double-effect… And how it comes to play in palliative care more often than most people think.

Say a person is dying of cancer. They opt for palliative care; they desist in any further cancer treatments, and take medication for the pain. Morphine is common. Morphine also shortens life.

It’s common for such a patient to have a degree of control over their own medication, however, after a certain point, they will no longer be in sufficient condition to do so.

After this point, it is very common for caregivers (be they medical professionals or family members) to give more morphine—for the purpose of reducing suffering, of course, not to kill them.

In practical terms, this often means that the patient will die quite promptly afterwards. This is one of the reasons why, after sometimes a long-drawn-out period of “this person is dying”, healthcare workers can be very accurate about “it’s going to be in the next couple of days”.

The take-away from this section is: if you would like for this to not happen to you or your loved one, you need to be aware of this practice in advance, because while it’s not the kind of thing that tends to make its way into written hospital/hospice policies, it is very widespread and normalized in the industry on a human level.

Further reading: Goods, causes and intentions: problems with applying the doctrine of double effect to palliative sedation

One last thing…

Planning around our own mortality is never a task that seems pressing, until it’s too late. We recommend doing it anyway, without putting it off, because we can never know what’s around the corner.