This article is the opening of my paper to the Elder Mediation International Summit, and explores advice from End of Life Doulas on helping families have end-of-life conversations.
As individuals we may (or most likely, may not) make Advance Plans, but how good are we at communicating those plans and wishes to those loved ones who may be present, involved and in good enough health to act upon, and advocate for, or even otherwise have blocked, our wishes, when the time of our death comes? What does it take for effective intergenerational dialogue to occur, whether between parents and children, aunts and nephews, cousin and cousin twice removed, older friend and younger friend?
Huge thanks to Elder Mediation International Network and Living Well Dying Well for their support of my research project seeking the advice of End of Life Doulas on ‘Helping families have end-of-life conversations’. My sincere thanks also, to the End of Life Doulas and later life practitioners of many different titles, who so generously shared their wisdom with me, and therefore with us all. I presented my findings at the Elder Mediation World Summit & Symposium 2018, and here below is the opening of my paper. You can access both my full paper and the presentation in links at the end.
Fellow Elder Mediators, End-of-Life Doulas, later life practitioners, relatives and friends.
I come to you today to present one idea, to tell you one story, and to ask one question.
- The one idea: It’s time to shake up intergenerational dialogue on death and dying, and we as Elder Mediators are beautifully situated to help with that good work.
- The one story: How my beloved Mum conveyed her end-of-life wishes to our family (brace, yourself – there’s some irreverence… but I assure you, it’s all hers.)
- The one question: End-of-Life Doulas are not mediators as such, but they have plenty of experience of brokering intergenerational dialogue on a person’s wishes for their death (aka Advance Planning), so as both a health and social care specialist mediator and an End-of-Life Doula, I asked myself, and a handful of fellow doulas, ‘What can we learn from End-of-Life Doulas about facilitating successful conversations between people, and younger generations, on communicating about what’s important to them when it comes to their own death.
In his 2017 autobiographical book, This is Going to Hurt, former hospital doctor Adam Kay underscored how brutal healthcare practices can be when guided by the principle of extension of life at any cost: ‘People don’t realise quite how horrific resuscitation is – undignified, brutal, and with a fairly woeful success rate [of around 16% within a hospital setting]. When discussing Do Not Resuscitate orders, relatives often want ‘everything to be done’ without really knowing what that means. Really the form should say, ‘If your mother’s heart stops, would you like us to break all her ribs and electrocute her?’’
So how do we ensure that healthcare professionals are not pitted against either patients or families in finding themselves committed to delivering ‘life-saving medical treatment’ when a life is naturally drawing to a close? How do we work towards helping people approach death in association with their families and healthcare professionals?
Non-medical initiatives like The Conversation Project and Before I Go encourage us to discuss end-of-life wishes’ with our loved ones ahead of death, or loss of mental capacity. It is clear that such conversations help healthcare professionals too. Let me give you an example…
I am going to make the unlikely segue from EMIN [Elder Mediation International Network] to…. Eminem. How? By sharing with you a US medic’s reworking of a song by Eminem & Rihanna….
[Please WATCH the video here – it’s a fantastic 3 mins, by a medic-turned-rapper, who took to rap to underline his concern about treating patients when there is no clear understanding about their end of life wishes.]
Thank you for reading this extract. You are invited to access the full paper, and my presentation slides, using the links below. There are two methods of accessing the material, as PDFs or on Google Drive:<
View on Google Drive:
Get Involved in the Movement!
Are you interested in becoming an End of Life Doula? Contact Living Well Dying Well.
Are you interested in becoming an Elder Mediator? Contact Elder Mediation International Network.
Are you interested in getting support for your family conversations? Get in touch with me!