The 'perfect death'

23rd May 2016

Is there ever such a thing as a 'perfect death'?

Perhaps not, but the key role played by nurses in implementing NIHCE guidelines on care of the dying adult is helping patients and their families come as close to it as possible.

It was back in December that The National Institute for Health and Care Excellence (NIHCE) said that patients approaching their end of life should be treated as individuals rather than a one size fits all, an approach we at Higgs & Sons have championed through advanced directives for some time.

In practice, this has seen the role of nurse elevated from simple clinician to communicator - the lynch pin that enables relatives and loved ones to fully understand the 'perfect death' picture built by the patient.

Talking can be one of the most effective treatments when it comes to working with those whose lives are limited and the essence of good nursing is to 'go beyond the clinical'.

Patients who may be facing imminent death or who have a longer or indeterminate prognosis will invariably be in an environment that is catering for their clinical needs. Care and attention to ensure their last weeks, days or hours are comfortable and pain-free are pre-requisites.

But equally important is the part played by the nurses who go above and beyond and offer themselves as a conduit, a vehicle through which a patient can explore and discuss potentially difficult issues.

Because despite the inevitability of the situation, the issue of how death should be prepared for may not have been broached - certainly not  to the extent where all those involved are aware of the practical and emotional  responses required to make the end of the person's life something that fulfils  their emotional and spiritual needs.

Therefore it is often the nurses, finding themselves in a unique and privileged position, who become the vehicle through which patients convey their wishes to loved ones who may be unwilling or unable to engage in such raw, emotive discussions.

Conversations about death often prove very much more difficult to hold with loved ones than they do with patients. And invariably, due to the strength of relationship built up between nurse and patient, it is the nurses who are able to objectively broach the subject of death and how it is to be faced. Their position allows them to see the wider picture in terms of the individual's needs and wishes and those of the family and friends.

And this is where advance directives can be such incredibly useful tools - they enable a patient to take control where little control is left to them and focus on the practical and positive.

The strength of a personally crafted advanced directive is that it can help individuals achieve a beautiful end of life which yes, encompasses their medical requirements, but more importantly their spiritual and emotional needs.

In facilitating the advance directive, and managing what is a difficult situation, nurses can help patients achieve a peace in knowing their wishes are truly being catered for, while also helping to ease loved ones into the bereavement process.

As a lawyer, it is then my role to take what is fundamentally a legal document, and ensure that it becomes not just a statement of fact but a recognised platform for discussion on which everyone involved is clear and satisfied. 

The positive effects of putting together an advance directive are a means unto themselves - perhaps even outweighing their actual functionality following death.

Fundamentals of an advanced directive:

  • it should be a document created to be Mental Capacity Act compliant
  • it should be valid ie. signed, dated and witnessed accordingly
  • it should accurately address the patient's wishes
  • it doesn't clash with any other document ie. LPA for Health and Welfare
  • it has been checked and (pre)discussed by the doctor(s) involved
  • it is distributed to all relevant parties

This article was originally published in the April issue of Nursing Older People.


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