Advance care planning: a family discussion

Thinking about life’s last stretch may be more difficult for the later starters in the race.

Thinking about life’s last stretch may be more difficult for the later starters in the race.

On March 2, twelve participants attended the first interactive workshop for advance care planning at the Omineca Medical Clinic.

Co-hosting the event with health practice support coach Heather Goretzky, Dr. Nicole Ebert looks to engage the younger population and have different generations at the next workshop in April.

“A lot of the people [here] are engaged, and not worried, already talking about it,” Ebert said. “We didn’t have the younger group…the questions would be different, such as medical intervention.”

For example, the CPR (cardiopulmonary resuscitation) procedure seemed to save all when it first emerge, though it is only useful for sudden heart stoppage and not for terminal illness, Ebert explained.

Instead, the discussion on advance care concerns more with general theory on identifying personal values.

“Then both sides can be talking in the same language,” Ebert said. “It’s for your parents.”

She explained that the difficulty for newer generations may be a cultural factor, recommending Atul Gawande’s book Being Mortal.

“Before, [life’s] a natural up-and-down cycle,” Ebert said. “Now it’s up, then up and down in a downward trend, with more days of struggle.”

An audience member who attended the event with her mother agreed.“My generation was the uncomfortable people…older ones are the ones where death was a natural progress of life,” she said. “I don’t fit the target age group, but I wanted to come…it’s a two-sided conversation.”

Others expressed that they already had the conversation with family members. “The kids are more concerned with keeping me alive,” an attendee said.

 

Questions to consider

 

Starting with a video from The Conversation Project that asked the audience, “have you had the conversation, not the one about sex, or drugs,” and told stories from younger perspectives, Ebert introduced key questions to think about, referencing resources from Dying with Dignity Canada:

What’s important for me? Do I like to be outdoors? Read a book?

On the last day, would I like to be at home, in the hospital? What would I like to eat?

In a chronic disease, what does the timeline look like? What are the complications, and what is the natural progress?

What do you fear the most i.e. independence in expressing, eating, or thinking?

Some might say, “Please let nature progress, and bring me back only if you can bring me back to a certain quality of life,” while others might feel that the deciding moment is the inability to go to the bathroom on their own, Ebert explained.

A document that records advance care wishes is a precaution, as well as a reassurance for the family when people cannot express themselves.

“If somebody can say what they want, they say it,” she said.

 

Healthy aging: not just about the final days

 

Another piece to the story is visualizing what the next years look like — which may include keeping fit and removing unnecessary medications, Ebert explained,

“If you can keep fit, balanced, and your strength, a lot of complications can be avoided,” she said. “Purpose, it’s the key to life; volunteer? Go out? Have a hobby? Carpentry?”

For Harvey Voth, the session was informative. In the past, he discussed advance care with his parents, who were open to the subject, but with his children, there was some resistance, he said.

“A lot of people didn’t want to talk about it, but we need to talk about it,” Voth said. “[My kids] wanted us to be not thinking about it, but living.”

He likes to remain active through home maintenance and yard work, as well as helping neighbours.

“I would like to do something everyday that I can do if I want, but when I don’t want to, it’s okay as well,” Voth said. “I don’t relish sitting around and putting puzzles together.”

So far, as he trades services with neighbours, he’s amazed by those who have the skills to repair items, he added.“We’re not all the same,” Voth said. “If there’s two people who are exactly the same, one of them is not necessary.”

 

Looking forward

 

For some attendees, the concern lies in not knowing who to contact when they encounter issues at home, while others expressed the difficulty in gathering seniors together from various locations.

Ebert said the clinic is looking to establish a community administration phone number that will contact the necessary service. Meanwhile, those encountering issues in the next six months can contact the clinic.

 

This is part two of the Omineca Express’ article series on advance care planning; part three will highlight available resources in the community for healthy aging.