I am acutely conscious of how precious time is for Wendy Mitchell, so I was already grateful to her for taking the time to speak to me about her thoughts on death and dying recently. I feel even more so now, having seen the unbelievably busy schedule she has got, promoting what she describes as her final book: One Last Thing: How to live with the end in mind. My copy arrived the day we spoke so I did not have a chance to read it beforehand but I already knew, from our previous conversations during my research for the My Future Care Handbook, that she was an ardent supporter of not only making plans for later and end of life but also of talking about it with the important people in your life, in her case her two daughters.
For those who may not know, Wendy received a dementia diagnosis at 58, almost nine years ago, and has spent her time ever since raising awareness of the disease and demonstrating first hand how there is life after a diagnosis. She has given hope to thousands who were allowed to believe their life was effectively over. Admittedly, the majority will not have gone sky diving, wing walking or abseiling or written two (three?) Sunday Times best sellers to prove the point, but Wendy, together with organisations like Deep, have highlighted to a worldwide audience how people living with dementia can continue to play full and active roles in society, with the right support.
Nevertheless, Wendy is well aware that dementia will catch up eventually. She tells me her bad days are becoming more frequent, hence my reference to time being precious, though I know she agrees we should ALL be living life on the basis that each and every moment is precious and not to be taken for granted. Whether or not we are living with a life limiting disease we are all going to die eventually, we just don’t know how or when. “Doctors would remind me that dementia is progressive,” says Wendy, “but nobody knows in life what’s going to happen – life itself is progressive – so you’ve got to live for every day.” And when the day comes, as Wendy says, “the more we have been able to plan and share our wishes, the more chance we have of a better death”.
When researching their book, Wendy and her co-author Anna Wharton interviewed, amongst many others, a man who was proud to tell them that he had all his paperwork in order. “He’d completed everything, everything you could think of, he was so pleased with himself. And the one thing we said at the end was, so what do your sons think? And he hadn’t told them. He never even thought of it. He thought by doing all the paperwork, that was enough… it was a light bulb moment for him… you could see his mind working: ‘Yes, I must. Why haven’t I done that?’
Picture the scene…
Doctor: I see your father has given you power of attorney. As you know, that gives you the authority to speak on his behalf. He has reached the point in his care where I’m not sure that further treatment is necessarily in his best interests. What would he want us to do?
Son: Er, I have no idea, we never talked about it.
“That’s what we need to get over to people,” Wendy continued, “it’s no good completing all the masses of paperwork if you don’t have a conversation… I thought the book would be getting people to talk about death, but actually it’s getting people to just have a conversation.”
Of course, both are important, as Wendy says: “you really cannot have one without the other.” The man in question might have written in full detail what his wishes were in such circumstances, and I would be the first to highlight the importance of putting your wishes in writing; people’s memories of conversations can differ, a conversation on its own is not enough. However, the paperwork on its own is not enough either, if you expect loved ones to understand and respect your wishes. As Wendy says, “the greatest gift you can give your children is to talk about the future and death.” A conversation is a two way thing, those speaking on your behalf and eventually left to settle your affairs should have a say in this too. You may not want a funeral, but should you not take into account what they might get out of a ‘good send-off’?
During our conversation we touched on the realities for people without family members to advocate on their behalf. Whilst there is no magic solution, we did agree that in these circumstances, writing down your wishes and ensuring they are available to any healthcare professional supporting you is just as – perhaps even more – vital.
It is of course no surprise that how to have a good death is increasingly on Wendy’s mind but I had not previously appreciated how strongly she felt about having the right to choose when we die. It is telling that the longest section in Wendy’s book, and the topic to which we kept returning when we spoke, is on assisted dying.
“The matter of quality of life is so individual; it always comes back to choice.” Wendy’s deal breakers, the things that for her make life worth living, are mainly physical: going for long walks, taking photographs, typing and of course her two daughters. She has already made it clear that she is not to be admitted to hospital under any circumstances, even if it risks shortening her life.
Wendy and Anna present a thorough scrutiny of the varying attitudes, laws and options available to people in different countries regarding assisted dying and it is difficult to argue with Wendy’s position that ultimately it should come down to personal choice. It also seems obvious that we should be listening very closely to those people living with a life limiting diagnosis; death is far more real to them than to those of us for whom it is an abstract event that will happen at some unknown time in the hopefully far distant future.
There is so much more in Wendy’s book that I want to explore further… about identity: are we the same person when we are deemed to have lost capacity through a condition like dementia, in other words should the choices we make prior to losing capacity take priority over anything we may indicate to be our wish subsequently? About control and choice: we want control over, and choice in, our lives, but how far can that go: we can’t control whether or not we die but should it be acceptable for people with a terminal diagnosis to choose and control when, with medical support?
Lots to mull over. One Last Thing is an informative, at times heartbreaking yet hopeful read, and a book I shall be returning to for top-ups of Wendy’s clarity, wisdom and honesty.
One Last Thing is available from:
The Book Room https://thebookroom.uk/product/one-last-thing/
Plus other book stores.
And the ‘great resource’ Wendy mentions (thanks Wendy!): My Future Care Handbook can be purchased here: