Sunday, 25 April 2010

Last Orders |Please

I had never wanted to live a long life. As a soldier one got accustomed to losing contact with people over the age of about 40 as they retired and adopted the life-style of civilians. I had no thought of retirement or what I might do when that time came around. My trade meant that I had seen a fair number of dead persons – all ages and both sexes. Many had long and painfully drawn out ends as in the case of a traffic accident, a botched suicide or enemy action. Some recovered but were faced with pain and disability; mental and physical. I had no powerful religious belief and thought of their fate as – basically – the way the cookie crumbled.

The change of life-style consequent upon my retirement led me down the path of introspection. The Black Dog days of depression. What if ….. Will I …..... All questions that had never entered my head in my earlier adrenaline-junky, hard drinking and fast living times. Looking back, I suppose a major event was having to arrange for a dearly beloved dog to be put down when diagnosed with something that could not be cured and only partially alleviated by medication that presented problems of it's own. The Black Dog asked me whether anyone would need to offer me the same relief I was able to give my pet. If required, who could meet that need? This had both legal and practical connotations. I was not in the best of physical health anyway and was concerned about the depth of my depression. These factors led me to conclude that I should not leave too much to be done by others. The thought of being left merely as part of some machine plugged into a socket outlet like a condom vending machine gave me serious concern.

I started off with a simple Do Not Resuscitate order. Copies at my GP and on a med-alert dog tag. This seemed to go down OK with family and my GP. Then, along came the debates and publicity about an individual's right to seek their own end, Dignitas and all that. Doctor Death polishing off the oldies in his care. I researched the Advance Directive. There seemed to be quite a lot of debate on the validity of such documents.

These appeared to come, in the main, from the All Life Is Sacred crowd or from doctors who took the view that they did not enter the profession to kill people upon request. I could think of many things that would not make me think that all life was sacrosanct and had had sufficient exposure to legal minds to know that anything was possible when wrapped in a 'whereas' or 'not withstanding' binder. My authoritarion years had shown me how to give orders that would be obeyed and not be just a basis for debate or argument. I spent a few bob and downloaded something certified to be appropriate for the vagaries of Scotland and set about amending this to be fireproof and valid. My superb GP gave a lot of useful advice on buzz words and phrases his profession recognised. I
none others.

It seems that there are a number of people who retain doubts. I respect that where they have taken the time and trouble to resolve these but remain unconvinced. Others may think it is a 'tomorrow' task or do not know where to start. For them, I reproduce below a copy of what I now have in place. It is not a scary thing and, so far as I can establish, likely to be complied with if the situations arises. If you see anything uncovered – please comment.

My GP has copies along with the hospital where I am most likely to receive treatment. My lawyer has a copy together with an instruction to immediately seek judicial action if my directions are thwarted.

It's Sunday – consider it a public service! I feel much better now mine is in place.


I, John Samuel Wood, residing at xxx born at xxx Essex on xxx August 1933, address this Advance Directive to my family, my GP and all other persons concerned.

This Advance Directive is made at a time when I am of sound mind, after careful consideration and without influence from any other person whether they stand to gain from my death or otherwise.

I DECLARE that if at any time:

1 I suffer from one or more of these conditions:

1.1 advanced disseminated malignant disease (e.g. cancer that has spread considerably);

1.2 severe immune deficiency (e.g. AIDS);

1.3 advanced degenerative disease of the nervous system (e.g. motor neurone disease);

1.4 severe and lasting brain damage due to injury, stroke, disease or other cause;

1.5 senile or pre-senile dementia (e.g. Alzheimers disease);

1.6 any other condition of comparable gravity.

2 I have become unable to participate effectively in decisions about my medical care; and

3 Two independent doctors (one a consultant) are of the opinion, having examined in full my circumstances and prognosis, that any of the following apply:

3.1 there is no reasonable likelihood of substantial recovery from illness involving severe pain and distress and from which it is likely I will die in the near future; or

3.2 I am in a state of unconsciousness or coma and it is unlikely that I will regain consciousness; or

3.3 I suffer from a mental illness resulting in me having a very limited awareness of my surrounding environment and an inability to perform basic tasks and from which it is unlikely that I will recover.

THEN AND IN THOSE CIRCUMSTANCES my directions are as follows:

1 That I am not to be subjected to any medical intervention or treatment aimed at prolonging or sustaining my life, such as those outlined in my Detailed Instructions below, even if this means that my life is at risk. This does not necessarily mean withdrawal of life enhancing medication as I would not want the withdrawal of any treatment which may reduce distress or provide pain relief or may adversely affect my quality of life.

2 That I consent to the control of physically distressing symptoms (including any caused by inability to eat, drink or simply receive nutrition) by appropriate and aggressive palliative care even if such care is likely to have the effect of shortening my life.

Detailed Instructions

The types of medical treatment which I would find unacceptable are:

Artificial resuscitation and/or artificial tube inserted through the stomach wall, up my nasal passage or by way of my throat.
Artificial nutrition or hydration.
If I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.

I cannot define in advance all illness or accidents that may involve this Directive. However, my intention in preparing this document is to make clear my intention and wish that it be implemented in the event of my entering into any such condition such as a permanent vegetative state or coma.

All and any medical terms to be read and construed as a layman would understand it without medical debate and discussion. Also, any consideration of what I have written should not include any religious input or concern.

At the time of establishing this Directive I have absolutely no intention of terminating my life. However, it has to be recognised that this may change if my quality of life deteriorates. It is my intent that should any of the outcomes I have described arise from my self-harming, the basic principles of non-intervention, other than pain relief, should be followed.

I consent to anything proposed to be done or omitted in compliance with the directions expressed above and I confirm that I shall not, nor shall my successors, raise any civil action against any healthcare professional for carrying out my wishes in accordance with the above directions. I accept the risk that I may be unable to express a change of mind at a time in the future when I am incapacitated.

This Advance Directive may be revoked at any time by me whether orally or in writing but otherwise shall be construed as representing my continuing wishes.

The name of my General Practitioner is: xxx

I have discussed this document with my General Practitioner xxxx before signing.

SIGNED by: John Samuel WOOD


Witness Statement

I testify that the maker of this Advance Directive signed it in my presence and made it clear to me that he understood what it meant. I do not know of any pressure being brought on him to make such an Advance Directive and I believe it was made by his own wish. So far as I am aware, I do not stand to gain from his death.

SIGNED by witness:
Witness name:
Witness address:

SIGNED by witness:
Witness name:

Witness address: