Have conversations about advanced care plans now

  • Interview

Have conversations about advanced care plans now

Dr Rachel Clarke, a palliative care specialist, on the BBC Today Programme on March 27 emphasised the importance of the psychological aspects of facing the end of one’s life.

Another human presence

"Patients will often be very frightened and very lonely. So one of the most important medicines in palliative care is the sheer value of close-up at the bedside of someone who is facing the end of their life. That’s what makes people feel they matter, they are loved, they are cared for and, crucially, they are not alone.

"One of the desperate cruelties of Covid-19 is that it’s denying patients who are dying or who are at risk of dying, the presence of their loved ones at the bedside. It’s absolutely heartbreaking.

Technology can help

"We (in hospital) are using Skype, Whatsapp, Tablets and Smartphones. There are ways of recording messages for your loved ones so that at least the love, that is very important for a patient who is masked and gowned and in Intensive Care, is there. At least then they know how much they matter to you. And of course, everyone in the NHS is striving to do their utmost to convey all the love and care for patients that their family members are not able to at the bedside. We (doctors and nurses) are human beings and we are trained to be there.

If the worst happens, what would you want?

"Something it is also very important for everybody to think about before a family ends up in a crisis situation, where somebody is rushed into hospital, is to have an advanced care planning conversation. This is when you chat with your loved ones about what they would like to happen to them if the worst befalls them and they become infected with COVID 19. The disease can take people over in hours. If you are elderly and also have lots of underlying diseases, it may never be appropriate for you to be put on a ventilator. And so the risk is of being rushed into hospital and you end up in an environment where nobody you know and love is there. If you had had the conversation in advance with your family you might have concluded: ‘If the worst happens, I would rather be at home with my loved ones. I would rather have them there with me.’

“It is incredibly important to have those conversations so that families do not end up in a situation where a doctor or a nurse says to you ‘Do you know what your Mum would have wanted?’ And your heart falls out of your boots because you realise that you do not know, because you have never had the conversation”

Listen here Two hours and twenty minutes into the programme