• drannetta

A radical new use of language to encourage advance planning? YES!

Updated: Sep 29, 2020

I have been approached quite a bit of late to speak about death and dying, and I always ensure that advance planning is in the mix. However, I always meet a good deal of resistance to the concept of end of life advance planning, and I think we need a radical shift in the way we think about and position advance planning. Today I take a quick look at one way I think we can expedite these essential end of life quality talks by changing the way we frame them. I invite you to come with me and take a moment to think about advance planning in terms of flight plans and travel arrangements, and how 'important' planning is to a successful trip...

Advance planning can be fun - trust me, I'm a Doctor!

Advance planning is a current hot-button issue for many good reasons - we need to get our rates of planning up as a matter of course for older community members as currently in Australia only 20% of aged persons who present to an emergency department have planning in place. The rate is slightly better in aged care facilities, where it doubles to 40%, but this is a long way from optimal as 60% (almost 2/3) of people still have not got advance health care directives in place. Most people have not talked about and written down what they want for their bodies and lives from a health and quality of life-perspective. In other words, total strangers in a high-pressure, high-turnover hospital area are making decisions FOR people in often critical situations where the patient is unable to represent themselves accurately and may not even be able to speak at all.

This is the health - literally life-and-death - equivalent of a pilot taking off in a plane with a passenger, but the passenger has not told the pilot which way they want to arrive at their destination (in this case the destination is death, as we all know), so the pilot has not filed a flight plan. The ripple effect here is that the pilot will be flying on surmise and best-guess without relevant information, and many, many other people's lives will be affected, most probably not in a positive manner. Imagine for a moment air traffic control, baggage handlers, ground staff, to say nothing of other pilots in the air...

Advance Planning is IMPORTANT and should be a normal, natural aspect of ALL of our lives

I am a big fan of planning things out in advance. Huge. I plan ahead for my work schedule, for my dog, for my time with friends. Advance planning is very important to me in my everyday life, and doubly so for end of life. Advance planning for our end of life health preferences and wishes, as well as for our preferred site and (when we have the legal right to choose) manner of dying, is essential if any of what we actually want is to come to pass. I am NOT the person who will get in a plane and just assume the pilot knows how to read my mind and that she will fly me where I want go without any input from myself. No, because I don't believe in fairy tale thinking. And I also do not think it is reasonable to leave everyone around me to make choices on my behalf because it's a 'tough' or 'uncomfortable' conversation. This, in the end, is the main stumbling block around the ongoing reluctance in our culture to talk about our end of life wishes, our health treatment and care options, and why death remains so taboo in terms of general conversation: WE PERSIST IN MAKING IT 'TOO HARD'!

Bollocks. Pardon the strength of my typing Gentle Reader, but conversations about advance planning are not challenging, difficult, too hard, tough, uncomfortable, or impossibly confronting unless we allow them to be.

When we shift our language around to acknowledge that advance health care directives, death and dying talks with close friends and family members, and final wishes are "important conversations" rather than "confronting/hard/uncomfortable/difficult conversations" to have we take a good deal of the fear and freakishness out of the idea of advance planning for end of life. File your flight plan for your end of life - it is the sensible thing to do. Yes, we all know what the destination is, we all end up dead. However, we can plan for our preferred and optimal routes to death so that we do not end up with unnecessary expenses, long and unwished-for delays, and travelling without the right documents - all of which always spoils our travelling fun.

When we all file end of life flight plans we will also help to normalise and integrate death and dying into our everyday awareness. I think this is a healthy direction to head for our society as an ongoing superstition and irrational fear of death as the Great Unknown will not ease by continuing to behave as though death can be put off forever if we keep it in the 'Too Hard' basket. And, as you have probably already figured out, normalising conversations about end of life and death is one of the driving passions of both my professional and personal life. When we keep a 'tough' concept at a distance we are forever frozen and stymied in fear and indecision - we feel quite OK with putting off a 'tough' or 'difficult' task as a cultural norm. However, we prioritise and take in our stride time-critical* 'important' tasks. We reward attention to the 'important' culturally, and we expect everyone around us to do the 'important' stuff as soon as possible.

*I use the phrase "time-critical" here deliberately. None of us know how much time we have left in our bodies, so have the important conversations NOW. Get your Advance Health Care Directives (AHCDs - or whatever you call the documents that give your instructions to health practitioners and your personal medical/health person of authority to speak for you in times of extremis) written out clearly, in full, and countersigned by your GP and a JP TODAY!

'Why use airplane metaphors?!?' I hear you ask - because we trust our lives to those who fly us, and pilots take time to undertake exhaustive check-list checking for safety before take-off as a matter of course. Pilots are incredibly well-organised. Pilots are good planners. Be like a pilot with your important end of life advance planning!

Would you find it easy to get into a plane with no flight plan filed with authorities, no way to tell the most important people in your life how you are going to get to your destination, and with a pilot who has no idea of the flight plan at take-off? I would not find this at all easy; and I suspect most of us feel the same - which is why we get into planes with the full confidence that we know where we are going and that, barring exceptional and rare circumstances, we will get to the destination in a pre-agreed manner. Do you want to end up in a hospital bed with no way to express your wishes for health care, resuscitation, drugs, and which people you would like to have around you? Or would you rather relax and enjoy your life knowing that, come what may in terms of health surprises, your plans are in place and your wishes are explicit? I am definitely in the latter category - I fly through life in style, knowing that all my important conversations have been carried out. Try it and let me know how this works for your peace of mind, I genuinely would like to know.

Oh, and don't forget that advance planning conversations are so important, you may think it a good idea to revisit them regularly. Practice makes for peace of mind and allows for changes in circumstances, preferences, and lifestyle. Go on, have an important conversation today! It'll be fun!

If you are unsure as to how best to begin an important end of life conversation please do not hesitate to get in touch with me. I am an End of Life Consultant and educator who specialises in listening, bringing humour and compassion to important conversations, and I also have a range of ice-breaker activities and ideas to help you get the important conversation rolling in a creative and stress-free way.

Let's talk. It is important -