A practical guide to preparing for end-of-life choices

Do you want to die in hospital full of tubes, or peacefully at home with loved ones? Now is the time to make proper arrangements, warns Hospice Palliative Care Association of SA (HPCA).

Death is an event that happens to everyone but most of us are ill-prepared for it, says Dr Liz Gwyther, head of the HPCA.

For this reason, HPCA is encouraging everyone to talk to loved ones about their end-of-life choices.

It has developed a basic questionnaire to guide people and their families about how they would like their healthcare to be managed towards the end of their lives.

“We encourage people to talk with their family and their doctor about their own choices and preferences in the event of experiencing serious illness or injury and to document our wishes for care if we are seriously ill or injured,” Gwyther tells Health-e News.

Surveys show that the majority of people would like to die at home with their loved ones, but that most end up dying in hospital. Meanwhile, the number of South Africans with advanced illnesses who die in hospitals exceeds internationally accepted norms.

Recently, Gwyther was called to the bedside of a very sick woman who was gasping for breath.

“Her family wanted to know whether she was in pain and if so, if they should call emergency services. I was able to assure them that she wasn’t in pain but that she was dying. That was all they needed to hear. She died a few hours later, at home with her loved ones. If they had called the emergency medical services, they would have hospitalised her and intubated her and she would have died like that,” says Gwyther.

HPCA offers palliative care to relieve pain, home visits from nurses and carers and emotional support to patients and families.

In January, Discovery Health became the first medical scheme to offer fully comprehensive cover for palliative care as part of an “advanced illness” benefit for terminally ill cancer patients.

The Advanced Illness Benefit provides funding for a multi-disciplinary palliative care team that could include doctors, nurses, social workers and home-based nursing and care worker services, as well as cover for Hospice services, as needed.

“Cover is guided by the agreed individual patient care plan. These costs are paid from Discovery Health Medical Scheme risk funds, and will not affect the patient’s day-to-day benefits,” according to CEO of Discovery Health Dr Jonathan Broomberg.

Dr David Cameron, who is assisting the HPCA to set up a palliative care institute, says that this benefit is a “game-changer”.

“It means that there can be career opportunities in palliative care for doctors,” says Cameron. “Oncologists have realised that they can refer patients to palliative care when their doctor-patient relationship has reached a particular stage, and patients will be able to decline further treatment while knowing that they will still be getting care.”

Discovery Health’s Dr Linda Holding says that feedback from members has been overwhelmingly positive, with more than 200 members already utilising the benefit. – Health-e News.

An edited version of this article was also published on Health24.com