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End of Life: Your questions answered Add to ...

Your question about asking for a do not resuscitate order might be best guided by your sense of what your sister would have wanted if she could have imagined the condition she is in, in conjunction with the support and advice you receive from your sister’s nurses, doctors about what is likely (we can never know with absolute certainty) to occur with her condition over the coming days, weeks and months.

My family never wants to talk about death or dying - I’ve tried to express my wishes (if I can’t breathe on my own, please DNR), but no one wants to hear it. What do you recommend I do? -George

George, your family is in common company – many of us don’t want to think about getting seriously ill. I think that talking about your wishes, with your family and friends, is important, and this will be helpful to them should they ever need to help make decisions on your behalf.

Although I’ve found it is very hard to predict exactly how people will react and make choices when they find themselves in such a situation, their general thoughts, if they can speak about them and write them down, can be quite helpful to their family.

In addition to speaking with your family, I’d recommend looking at some examples of advance care directives that might be a good guide for your family, even if it is hard for them to talk about it now. The Speak Up website offers some very helpful resources for us all.

I’m about to be the primary caregiver to my father - who is very sick with stage 4 cancer - in his home. Do you have any advice? When should I call for emergency help? What are the signs that death is very close? - Robbie

Hi Robbie. First let me say that it is very admirable that you are taking on this responsibility. Second, I would point out that there are several resources available to help ensure patients can die peacefully at home, for example with help from some palliative care teams. (You should speak to your father’s doctors or a social worker to help give you some suggestions.)

You don’t even necessarily need to call emergency when death seems imminent, as long as steps have been taken to ensure that your father can die peacefully and without suffering. However, if these strategies and treatments aren’t yet in place, you should look for any signs that he appears uncomfortable or in distress, for example having difficult or laboured breathing, to seek support from a hospital. But it’s much better to plan ahead like you are doing, so that he doesn’t need to suffer needlessly.

My sister’s directive was to have me as her primary caregiver, in her home, when the hospital couldn’t do anything more. that time has come - I’ve been caring for her for 7 months now. My question is - as odd as it may sound - what actually medically defines death? - Ruby

Ruby, your question isn’t odd – in fact it’s very good. You might be surprised to learn that there is no Canada-wide legal definition of death. In Canada, each province oversees and manages its own healthcare system, and this means that there are slightly different legal definitions of death across the country. However, from a very practical standpoint death is determined when a physician (or a coroner) identifies that there is irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain.

In other words, if the person is no longer responding to any stimuli, the pulse is no longer present, and there have been no breathing efforts – and this persists for at least 5 minutes or more, then the person can be pronounced dead.

I want to create a living will - but my husband argues it’s easy for a healthy person to ask for a DNR. He says I’d change my mind - if I do, when that time comes, how easy is it to change? Or is that set in stone now? -Jamie

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