Tag Archives: The Big Conversation

Suicide – The aftermath

20 Jul


Suicide – The aftermath


The politically correct way to discuss suicide is to describe it as “taking their life” as the phrase “committing suicide” refers back to the time when it was criminal and is therefore a shortened version of “committing the criminal offence of suicide”.  Taking your own life is not a criminal offence, aiding, abetting, counselling or procuring (ie helping or encouraging in any way) are all still are criminal.


Taking their own life, is the biggest killer of men under the age of 45 in the UK.


So when someone takes their life, the friends and family that are left behind are hit by the tragedy.  Before they took their life, options are possible, there are choices, even if that person doesn’t see them for themselves.  Afterwards, those options have gone.  And they are never coming back, so nothing will ever be the same again.


If someone attempt to take their life unsuccessfully, then the options are still possible and those around that person are on notice that they need help, even though they might not have asked for it.  It can entirely change the situation, as the person may have done serious harm to themselves in the attempt and their life is irrevocably changed by the new situation.  And the person, their family and healthcare professionals all must deal with the outcome and the new situation.


If someone is successful at taking their life, those who are left behind are firstly numb, then the questions start.  What could I have done differently?  What opportunities were missed?  And by whom?  And all whilst this is going on, there is sadness.  Sadness for the life that could have been.  And a sense of loss of the missed opportunities and lost life.


The family and friends will be bereaved and have stress to deal with and may well become depressed.  The families that I deal with when their loved ones took their own life really struggle, they are confused and their speech can get confused, it is all a sign of their stress and anguish.


When someone takes their own life, it is sad for the survivors, but they did it because they saw it as their only choice out of their pain.  It is not an easy decision, it is not the decision of what to eat for dinner or what colour shoes to wear.  It is a big important decision and it takes a lot in the moment to carry it out.  For the family who are left behind afterwards, you have my sympathy, living with the aftermath is very hard.





Do Not Resuscitate – Completing a TEP

29 Jun

Do Not Resuscitate – Completing a TEP


Firstly, what on earth is a TEP?  Many of us will have heard of DNR orders, but have no idea what a TEP is, it stands for Treatment Escalation Plan and is the NHS document regarding end of life and resuscitation.


It has 3 sections; part A looks at whether this patient is at the end of their life with a poor prognosis and starts the question “Would you be surprised if this patient died within the next 6 – 12 months?”.  When I talked to healthcare professionals about death and dying, they will often say that they cannot predict when someone is going to die.  They can try and they will often get it right or close to being right, but not always.  People can unexpectedly rally and recover and continue to live for months or years.  I had a client who was Catholic and approximately annually the priest was called in the early hours of the morning to give her last rites and asked not to wait until office hours as she wouldn’t survive until then.  She finally succumbed in the 4th year, having survived last rites 3 times!


The next bit of section A looks at any advanced decisions that person made and whether they have the capacity to participate or make the decision themselves and if they haven’t, it allows the doctor to decide whether or not to resuscitate in the event of cardiorespiratory arrest.  In other words, is someone going to do CPR (chest compressions and restart their heart if it stops).


Part B then looks at a slower less dramatic decline and considers the circumstances “If the patient is currently very unwell or in the event their condition deteriorates”.  There is a series of boxes to tick Yes/No including some that are only relevant in hospital (aka acute setting).  The 5 questions for outside of hospital are:

  • Is admission to acute hospital appropriate?
  • Are IV fluids appropriate?
  • Are antibiotics appropriate?
  • Is artificial feeding appropriate?
  • Is De-activation of Implantable Cardioverter Defibrillator (ICD) appropriate?


TEPs are important documents, they are life and death decisions.  They are not however written in stone and can be changed by a doctor at any point in time that circumstances change.  And when circumstances change a new TEP is completed and placed in the patients notes.  Until it is changed, the current TEP will be followed by the healthcare professionals looking after that person, including doctors, nurses and paramedics.


I’ve seen lots of these completed, I’ve even been part of conversations around end of life in vague non-specific terms, but I’ve yet to see a doctor complete one in full consultation with the family, so they clearly understand what a tick in each of the boxes will mean.  It does have to be completed by a doctor, it is their signature on the form, but even when there is a health and welfare attorney with authority to make decisions about life sustaining treatment, the doctor still doesn’t fully consult with the attorney, or at least I’ve never yet seen that.  This means that they can get it wrong!  Not every family member wants to discuss this in detail and if they don’t that’s fine, that’s their choice.  But they should be given the option!


Part C is about organ donation, so is only relevant at the time when the other decisions are all over!


TEPs can be scary, they deal with circumstances that family members don’t want their loved ones to be in – very poorly!  If anyone needs support in dealing with a TEP or understanding it, then let me know.  I’ve been involved in others and I understand.













The Big Conversation – Dying Matters!

16 Feb

A coffin with a flower arrangement in a morgue



There are a number of different organisations that are involved in this subject of talking about dying.  We live in a death phobic society, we rarely see real dead bodies, just fake ones in movies.  When a neighbour dies, they are not laid out in the dining room for the neighbourhood to come and pay their respects or anything like that anymore!  We avoid using the word “death”, there are lots of other sayings: “fallen off their perch”, “gone to the other side”, “passed on” etc.


And yet, this is something that eventually we will all do, yet we don’t talk about it much.  Lots of families find this a very difficult and uncomfortable conversation, but often once that first barrier is broken, of starting the conversation, the whole thing becomes much easier.


It is entirely understandable that people want to focus on living and therefore want to talk about living, about the exciting things they want to do with their life, the place they want to go on holiday this year or just what’s for dinner!  But it is still worth having a conversation, perhaps once a year or every other year about what you want to happen as you are dying and after you have died.


What sort of end of life treatment do you want?  Who will make those end of life decisions if you can’t?  What do you want to happen if you have a 50% chance of survival?  But what about a 70% survival chance or a 10% chance.  And what does “survival” really mean?  What is it about your life and lifestyle that is important to you?


And once you have died, what sort of funeral do you want?  Who do you want to be there?  Do any of these decisions matter or do you want your family to make some or all these decisions?  Is your family going to hold a wake, should there be a theme?  How do you want to be remembered?


In legal terms, this also leads into the making of a Will, which I have blogged about before.


Your family will be sad that you have died (hopefully) and one of the important ways that they are comforted in their grieving process is to be able to fulfil your wishes.  They can only do that if they know what your wishes are.  And they will only know what your wishes are if you have had a #BigConversation with them!

How to prepare for the future – part 4

4 Aug

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How to prepare for the future part 4


When I gave my talk at the #BigConversation, I discussed creating a Will, Powers of Attorney, having a discussion and then getting your paperwork in order.


Filing is usually no-one’s favourite job, but it is necessary.  It doesn’t matter what system for keeping your records in order, just as long as it is clear.


In your conversations with your family members, if you want, you can tell them as much as you like.  You can tell them how much money you have and where it all is held along with other information such as who your pension providers are etc.  The choice is entirely yours. If you choose not to tell them, then they will need to know where to find the information and therefore perhaps that is all you tell them.


It is useful to keep your paperwork in some kind of logical manner, so that when the person dealing with it (Executor or Attorney) finds it, they will be able to understand the picture of your finances fairly easily.  You may want to also have a file of obsolete paperwork, so that they can know what is no longer current, just in case they knew about it before, but mark it old obsolete paperwork, so that they will realise that!


It is not a good idea to leave your telephone banking and/or internet passwords with your paperwork, which is just for you.  If your Attorney or Executor needs to access your account, they can do that in their own right.  Using your access masquerades them as you and that is not how they are acting, you have given them authority in their own right.  That way their actions are traceable and they can be asked to be accountable for their actions.  The other issue is the risk associated with leaving your passwords around, as anyone could come along and access your account if they found it, so your are at risk of theft.


If you choose to leave your paperwork in a mess, then it takes hours to find everything, go through it, work out what is current and deal with it.  It might also include lots of wasted letters or it could mean that whoever is looking after you has to instigate an asset search.  Speaking from personal experience, when I have dealt with messy affairs, it takes hours and a lot of space on a very big table, it is frustrating and if the person has appointed a professional, will cost lots of money that it didn’t need to.


It may be boring, but get your paperwork in order, it will make life lots easier for you and for anyone helping you!

How to prepare for the future – part 3

21 Jul

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How to prepare for the future part 3


Having already said that you should make a Will and create Lasting Powers of Attorney, the next thing to do is sit down with your family and have that conversation about what you want in the future.


Lots of families find this hard, they don’t want to talk about that difficult stuff, when you might be unwell, dying or after you have died.  Usually once the first conversation takes place, it makes it easier for the next one to take place, as this can become a theme that you may come back to if things change in your life.  This does not mean that you will keep having this conversation all the time, it might only crop up rarely, but it is not something to shy away from.


Getting started can be hard, so the easiest way to start is to pick the most important topic to you, is it unwellness or death?  Then think about what that means for you and what is important to you about that subject, this can be the starting point.  Find out from your family how they think about it and what is important for them.  You may know exactly what music you want at your funeral for example, but if they would hate it and it would do nothing but upset them, then perhaps you might rethink or they might have to.


Having tackled one of these subjects, it will then make it easier to talk about the other one and what is important to you and them about it.


This conversation needs to be in a place where all parties feel safe to say how they feel.  And there can be no judgement; there are no right answers or wrong ones for that matter.  It maybe that this is particularly difficult and the conversation could elicit emotions you or they were not expecting, which may means tears or anger for example.


To get you started you can always find out if there is a death café near by and go along to that, so that you can get that conversation going.  There are many around, if you follow the #BigConversation.


Once you and your family have had this discussion, it will become a plan for what should happen when the worst happens.  You may not become ill, but everyone dies, so sooner or later this will happen to you and your family.  And it will be devastating for the survivors, which is as it should be.  But when that devastation hits, at least your family will know what to do, they will know what you want and following your plans and discussions will provide them with the comfort that they know they are doing what you discussed.  And before that happens, you have the comfort of know that this is what will happen.


The scars of bereavement take a while to heal, but knowing that you are doing what the deceased wanted goes a long way to helping those scars heal and the survivors move on and have loving positive memories of their relationship with you.

How to prepare for the future – part 1

23 Jun

Envelope with Last Will and Testament

How to prepare for the future


I was asked recently to talk about what are the 5 top tips for preparing for aging and any potential decline in wellbeing that that might bring.  And the answer is more straightforward than that, as I came up with a top 4!


The 4 things are:

  1. Make a Will
  2. Create Lasting Powers of Attorney
  3. Have a conversation with your family
  4. File your paperwork & keep it organised


So starting with making a Will, why is this so important?  It allows you to choose where your belongings go.  Even if you don’t own lots of things of value, people still want to be able to remember you when you have gone and to have a memento of someone who has died is a lovely way to do that.


It allows you to appoint Executors, who are the people or person who will make sure your wishes happen, they are the people dealing with the paperwork.  They can also be beneficiaries, but they don’t have to be, the 2 separate roles are different.


As well as appointing Executors, if you have children under the age of 18, you can appoint Guardians for those children.  In the event of the death of a parent, the other parent with parental responsibility will primarily become the carer, unless there is reason not to allow that to happen and the Family Court can intervene.  The Family Court will take into account the best interests of the child, which will include any appointment of Guardians in the Will.  Not all cases end up in the Court if the matter is uncontested by the various parties involved, it should be the destination of last resort for a dispute.


On top of Executors and Guardians, you can make a funeral wish, which is simple terms is whether or not you want to be cremated or buried, but can include much more detail if you want.  I have had entire memorial service directions, including who will read which passage and a hymn list.  It doesn’t have to be in that detail, but if you have a wish, let your family know, so that they can carry it out, it is usually comforting to them to carry out your wishes as a last act of love for you.


The final part is leaving your estate, ie all your assets, to whoever you want, possibly including family, friends and charity.  If you have people who are reliant upon you, then it is best to leave them something, otherwise they can make a claim on your estate, but other than that, you are free to leave your estate to whomsoever you like.  Most people leave it to their family or part of their family and if you are going to disinherit a member of your family, it is helpful to give information as to why, to help to rebut any claim they may make.  Family disputes are completely normal, most families don’t get on, it is only about the degree with which that happens!  So when these disputes become so difficult that the only way to deal with them is via lawyers, whilst the lawyers will love it, the family is losing money!  You cannot stop someone from disputing a Will, the best that you can do is limit their chance of success, which will hopefully reduce the cost of litigation.


So if you want to prepare for the future, make a Will, as long as you are over the age of 18, there is no time when it is too early, but there can be a time when it is too late!