trouble . . .

. . . according to Confucius, is what you’ll find right at your door if you don’t plan ahead. In a previous post I mentioned advance care planning (ACP) as a process “of reflection and communication … a time for you to reflect on your values and wishes … to let people know what kind of health and personal care you would want in the future if you were unable to speak for yourself.”[1] The key is to have these conversations early on when you have time and capacity for it.

Monk prays for a deceased passenger in Shanxi Taiyuan train station (China, 2012)

Recent research in the UK found that people with advance care planning “are more likely to have their wishes respected, have fewer unwanted interventions, experience reduced transitions between care settings and are more likely to die in their preferred place of death.”[2]

To find out how things work where you live, search for “advanced care planning” and “name of your city, state, province or county”. In my home province of British Columbia the government publishes an excellent Advance Care Planning Guide available in hard copy or online: all at no cost.

Prior to meeting with members of my future care team (who, it turned out, had never met in the same room) I prepared a list of generalities and specific. Prior to posting I’ve added links re specialized terms. The initials shown in [square brackets] indicate those who’ve agreed to be of service. I bow to their compassion. May their hearts truly open under the strains of this commitment.

Here goes:

• I wish to age in place. This means having access to supports and services so that I may live safely and independently in my home and neighbourhood for as long as Possible. [V] knows what it means to age in place. See also.
• When necessary convert dining room and move bed or rent hospital bed, equipment, and supplies are needed. [D] has power of attorney regarding costs. Please avoid the ambience of a hospital room.
• Keep [H] my executor informed of developments.
• Inform friends and relatives if condition becomes critical or potentially long-term. [M] has the contact list.
• Arrange paid personal care to assist with comfort, diet, clothing, hygiene, exercise, safety, etc. Use upstairs rooms for time-out and overnight stays.
• Invite and encourage a gentle flow of visitors. Welcome gifts (such as food) and limit visit durations as appropriate.
• Take good care of Waldi my beloved canine companion. Let him stay close to me. [N] knows what he likes and needs.
• I wish to continue teaching meditation online and to have access to spiritual care. My Buddhist teachers [C, H, L] are aware of this request.   

Interventions I’d welcome

• “Medically appropriate care” consistent with my condition and goals of care.
• Anything to give joy to me and those that care for me.
• Care in line with medical orders of scope of treatment (MOST) which are on file at doctor’s office. My current level is M3.
• A “natural death” with medically appropriate care for symptoms, such as pain or shortness of breath, as death approaches.
• Palliative care that addresses physical, psychological, and spiritual concerns with focus on comfort and respect for decisions. Service of home hospice over institutional care.
• Assistance in considering medical assistance in dying (MAiD). It’s legal in Canada and several States. Patients with a diagnosis of advanced dementia are eligible in Canada. [T] knows the ins and outs.

Interventions I would refuse

• Life-prolonging medical interventions.
• Such measures as tube feeding, use of a ventilator, and kidney dialysis.
• A do-not-resuscitate order (DNR) is posted on the kitchen fridge and filed with Dr. H (physician).

[1] Chinese philosopher and political thinker, 500-400 BCE  [2] Steel, A.J & Owen, LH (2020). Advance care planning: the who, what, when, where and why. British Journal of Hospital Medicine, vol. 81, no. 2, pp. 1-6. doi: 10.12968/hmed.2019.0396