A time to reflect and plan: 3 questions about end of life ? The ...

One of our most popular posts in 2012, was Dr Peter Saul?s call to action encouraging us to ?occupy death??at TEDxNewy.

In the spirit of Peter?s message our final post this year is?dedicated to people living with terminal illness and with dying this holiday period.

The end of the year is often a time to reflect on the year that was and a time to make plans for the year ahead. Planning for our dying however, is rarely discussed easily and less than 10 percent of Australians prepare by developing an Advance Care plan.

In this guest post from GP?Dr Edwin Kruys,?he?explores 3 common end of life questions.

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3 end-of-life questions we all need answered

The transition from curative to palliative care sometimes feels like an emotional roller coaster. To reduce stress and fear of the unknown it?s good to have a look at what lies ahead.

I recommend that people talk to their GP in an early stage to discuss the issues surrounding dying. This is a difficult and emotional conversation for all parties, but usually there is a sense of relief afterwards. Here are three important questions patients and their family members always ask me when the end is in sight.

How long will I live?

This is always hard to say. I honestly often can?t tell, especially in the early stages. When people stop eating or drinking it is usually a matter of days. I urge people to do what they need to do when they still feel well. Start today ? don?t wait until tomorrow. This may include talking with family about end-of-life preferences and sorting unfinished business.

It is advisable to organise a will, power of attorney, and advanced care directives, as well as a funeral home. Talk together about support and/or counselling for family, friends and carers during the deathbed and afterwards.

Dying is a gradual process. The body is slowly shutting down. The dying person will experience loss of appetite, diminished energy levels, and weakness. There is a gradual loss of interest in activities. Uncomfortable symptoms can be treated, such as pain or shortness of breath.

What can we expect?

There is huge potential for growth of the mind during the last stage of life. This is a time when people look back on their lives in a philosophical, spiritual way and strengthen the bonds with their loved-ones.

Dying can also be very lonely, especially if the communication with others is limited. Friends and family members may not know what to say or feel uncomfortable talking to the dying person. This can lead to social isolation. Professional help, like counselling, is sometimes required.

During later stages the dying person will be less interested in social interactions. Contact with close family and friends becomes a priority. The patient will usually sleep a lot.

Image: When I was writing this article, my 3-year old daughter Jill made this drawing. I thought it was a beautiful illustration of the emotional roller coaster during the final stages of life. In my experience most people eventually find resolution and are able to die peacefully.

The patient may stop eating and drinking altogether and go into natural dehydration. There can be difficulties with swallowing and confusion may occur. Reduced urine output and less frequent bowel motions are common, as is incontinence. Shortly before death the breathing pattern changes. The colour of the skin may become bluish.

During this end stage people may have their eyes closed but can often still hear. It?s good to talk to the dying person. Some say we should let them know it is ok to let go.

Medication is available to, for example, reduce the sensation of thirst and manage confusion. In Geraldton we have a fantastic palliative nursing team that enables people to die peacefully at home or in a hospice if they wish to.

Will I be in pain?

No, in almost all cases it is possible to control the pain and keep people comfortable. Managing worries and anxiety also helps to reduce pain levels. Medicines can be given as tablets, capsules, liquids, patches, and continuous infusion.

Further reading: http://www.palliativecare.org.au

Dr Edwin Kruys is a rural GP in Geraldton, Western Australia. He writes a blog for the Panaceum Group.

Follow Edwin on Twitter: @EdwinKruys

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Our thoughts are with the many family members and caregivers caring this holiday season.?If you are a caregiver there are some tips for caring during the holiday season?here.

We would like to thank Dr Edwin Kruys for contributing to the final GroundSwell Project blog for 2012. If you would like to contribute in 2013 please contact kerrie@thegroundswellproject.com for more information. In 2013 we are launching a national initiative that encourages greater awareness and promotes community actions about the experience of death, dying and bereavement. We look forward to sharing more details with you soon, in the mean time please follow us on Twitter and Facebook.

Source: http://thegroundswellproject.com/?p=2353

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