My advance care directive is only short. I don’t want to say too much, be too specific and I’ve been very deliberate about this. Today I popped it up, sorting to the top of my list of computer folders. Of course I hope it won’t be needed for many years. But now it will be the first thing anyone finds when they go looking for it.

If it’s short, why bother?

The most important aspect of it is that I’ve said anything at all. Now that it’s written and saved, in NSW where I live, it’s a legally binding document. In some other states and countries such a document would need to be signed and witnessed, but not here. 

Having written my instructions down means they will be followed in two circumstances that are important to me:

• when I’m not able to say anything at all. This is most likely to be when I’m unconscious 

• if I’m suffering from dementia, a common scenario of old age these days.

My three daughters are my ‘persons responsible’

Entwined with it is a clear instruction that I want my children to be empowered to make decisions on my behalf. To make this really official, I could see a lawyer and make my daughters my “enduring guardians”.  But at this stage they would be recognised as the “persons responsible”.

Every couple of years I’ll update my advance care directive. I’m not expecting huge changes in what I want but you never know. I might actually not make any changes at all. But by re-dating it, that gives my family the confidence that I’ve looked at it and thought about it recently.

Despite working in the area of advance planning, I’d put off filing it as a ‘finished’ project because I thought it was too short, and needed more work. But I read about Sheila Kitzinger’s in The Guardian and realised hers was only short – and surprisingly similar in it’s key points and brevity. This gave me confidence in mine – just as it is.

Ideas about a good birth and a good death can be similar

Sheila died in 2015. She was a British advocate for natural childbirth. This sounds radical. But a lot of the things she advocated for have been brought back into childbirth today. These include labouring in a darkened, quiet space, having a bean-bag to roll on, being at home if it’s safe for the baby and practical.

Like my mother who was a midwife, Sheila didn’t believe women should be forced to lie on their backs during labour. This seems like common sense today but both women were scathing of the use of stirrups in childbirth – a device that helped the doctor but not the mother. It was common in their day. 

Of Sheila Jenni Murray wrote in the UK’s Daily Mail:

“She was never so radical as to deny there can be difficult pregnancies. She wanted women to be accompanied in labour by a sensitive, qualified midwife and for life-saving technology to be available if things went wrong.”

“Sheila said it was important to have a birth plan, make your wishes clear, but be prepared to listen to advice should things take a dangerous turn.”

Celia and Jenny’s tribute in The Guardian

In a tribute to Sheila two of her daughters Celia and Jenny wrote for The Guardian, when Sheila died in 2015, they describe how their mother made a death plan – so she could die at home according to her own wishes.

“Sheila’s death plan was a single paragraph (signed and witnessed, and legally binding on her carers and medical professionals) which declared: “If the time comes when I can no longer take part in decisions for my own future, I want to receive whatever quantity of drugs can keep me free from pain or distress, even if death is hastened. If there is no reasonable prospect of recovery I do not consent to be kept alive by artificial means. I do not wish to be transferred to hospital and should like to die in my own bed.”

“Except for the last few days, when she was unconscious, Sheila was able to communicate her wishes herself. But her AD was immensely valuable in supporting her choices,” they wrote.

To read more about Sheila’s good death, go to:

https://www.theguardian.com/lifeandstyle/2015/jun/19/how-to-plan-for-a-good-death-sheila-kitzinger 

For details on writing an advance care plan in NSW, go to:

http://www.health.nsw.gov.au/patients/acp/Publications/acd-form-info-book.pdf

Good Grief! is an independent blog to help navigate grief, update rights and opportunities for the dying and support all those involved. To find out more and to subscribe, go to:

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