The Will to live - and die

Geriatric doctor David Jarrett’s living statement and will show you how to get the best care – and enjoy your last years

Having witnessed over many decades the multitude of sufferings and indignities nature, aided and abetted by modern medicine, can heap upon the elderly, I had a stab at my own living statement and living will.

These are my first attempts at expressing my wishes for the future, should I become mentally incapable of deciding things for myself).

The Living Statement of David Jarrett

I David Jarrett of Weary Cottage, Exhausted Lane, Knackeredton, do declare that I am of sound mind and hereby state my preferences for care if I become physically and/or mentally incapable of caring for myself.

I do not want much fuss made of me in any way and do not expect or want my children’s or grandchildren’s lives to be burdened with my care in any significant way. Their lives now take precedence over my declining life.

I would like to remain in my own home for as long as possible but if I need institutional care, then nothing should be done to unduly prolong that care (see my living will).

I do not take sugar in tea or coffee. I have always enjoyed the grain and the grape and would like this to continue until I die, whatever the medical advice to the contrary. I enjoy music and would prefer a selection from my favourite CDs: 1970s prog rock usually hits the mark. These are the albums and a few favourite songs, I have listened to all my life and feel it unlikely that I will ever tire of:

Close to the Edge, Yes; Trout Mask Replica, Captain Beefheart

Early Roxy Music;Astral Weeks, Van Morrison Soft Machine: Third and Seven

In Praise of Learning and ‘Oslo’ (on side 3 of Concerts) Henry Cow

Three Little Feelings, Miles Davis

Miles Davis’s Kind of Blue to calm me down and The Prodigy’s Fat of the Land to wake me up.

I am also partial to English songs of the Peter Warlock variety.

How much life might I be depriving myself of? A year or two? A few months? That is in the lap of the gods. Many human perceptions such as the passage of time can be measured accurately – say, using a clock. There is a hypothesis in psychophysics – Weber’s Law –which explains that what we can perceive as a change in a stimulus is proportional to the scale of the original stimulus.

So, as an example, if we have a 50g weight in one hand and a 60g weight in the other, we are able to tell which is the heaviest. But if we try the same test with 200g and 210g weights, sensing a definite difference is not possible.

We can hear a whisper in a quiet room as it is a pronounced sound compared to silence, but we cannot hear the same whisper in a crowded room with a lot of background noise.

There are certain films I love and am happy to watch again and again. So if I need distraction, put on The Godfather or The Godfather Part II, any film by David Lynch but particularly Blue Velvet or Mulholland Drive, Providence by Alain Resnais or Monty Python’s Life of Brian. If I cannot engage with these films, you can conclude that I am severely demented (see Living Will).

I eat almost anything but on high days and holidays I love an oyster or two and a glass (or two) of cold Chablis would not go amiss. I would like on occasions to see the sea and feel the wind and spray. Don’t worry if I get cold. That’s part of the experience.

Please do not have a reproduction of Constable’s The Hay Wain hanging in my room. His oil sketches are sublime but his big paintings are tedious. Giorgio de Chirico’s Mystery and Melancholy of a Street or Salvador Dali’s Basket of Bread – Rather Death Than Shame, or any Edward Hopper nocturnal city picture, except Nighthawks, would do nicely.

When I die, I would like to be cremated. The music for the service should be The Plains of Waterloo by Eddie and Finbar Furey, A Rainy Night in Soho by the Pogues and Angel Band by the Stanley Brothers and, as my coffin (cheap cardboard, please) is whisked away, Solemn Music by Henry Cow with A Soft Day by Charles Villiers Stanford, sung by Kathleen Ferrier, as family and friends leave.

Charity donations should be for something to do with animals but if people want to give to a human charity, my choice would be Faith to Faithless, which supports those giving up religion for atheism.

The catering arrangements should be sufficiently generous that everyone agrees it was ‘a good send-off’.

My ashes should be divided, with half sprinkled on the sea at Hayling Island and the other half scattered around the streets of Soho.

Weber’s law also applies to our perception of the passage of longer periods of time. When we were children, the year between one Christmas and the next seemed an eon. And it was.

The difference between being five-years-old and six is one fifth, or 20 per cent, of the life lived so far.

But the difference between being 80 and 81 is one eightieth of your life – just over one per cent. That is why we feel, with every passing year, that birthdays seem to come and go with terrifying rapidity.

So the time we gain in old age from interventions and medicine’s unrelenting pursuit of prolonging life is perceived as shorter by us than it seems to the younger generations of our family. The resources needed to sustain this life are the same, whatever the age. The flame of life burns bright in youth. Sadly, in our dotage, it is often but a feeble spluttering flame that can be extinguished by the merest breath of wind.

So, any lost few days, weeks or months, or even years, in extreme old age would have flown by like the weaver’s shuttle.

It’s the law of diminishing returns again. A huge input for little discernible gain. For most of us, those extra months and years spent immobile, in pain, deaf, blind and disorientated are not going to be the most treasured of one’s life.

Extracted from 33 Meditations on Death by David Jarrett (Black Swan, £9.99)

For advice on how to make Living Statments and Living Wills, go to the Age UK website - www.ageuk.org.uk

The Living Will of David Jarrett

I, David Jarrett of Crumble House, Wizened Road, Decrepit-on-Seam being of sound mind, hereby declare my wishes in case I become mentally and/or physically infirm.

I have enjoyed at least sixty years of healthy life, for which I am grateful. I have always believed life is for living. The presence of life itself without the mental or physical capacity to enjoy or participate in the world has no appeal to me. I do not believe suffering has meaning or gives meaning to life. To that end, I will outline how I want the final period of my life to be managed for my own best interest and the interests of my loved ones.

If I develop dementia, I do not want any life-saving treatments or primary or secondary preventative medicines such as blood-pressure treatments, cholesterol-lowering medications or disease-modifying drugs for heart failure, diabetes or any other common ailments of old age.

I do not want influenza vaccinations or pneumonia-protecting inoculations. If I develop pneumonia, I do not want antibiotics but would want symptom-controlling medications such as oxygen and opiates. If I have a heart attack or a stroke, I do not want interventional treatment, operations or life-prolonging medications.

If I am unable to swallow, I do not want intravenous, nasogastric or other methods of feeding and hydration. Distressing symptoms should be managed as for palliation. Non-life-threatening infections such as skin and bladder infections can be treated to relieve any distress.

Cancer treatments should focus on reducing suffering rather than prolongation of life. I am at this time, when sound of mind, willing to accept one course of radiotherapy and one standard course of chemotherapy but if, or when, the cancer returns, then I want no secondline chemotherapy or radiotherapy. I certainly do not want bone marrow transplants or immunotherapy.

When the end is in sight, I want morphine in generous doses. I do not want doctors or nurses hounded if I choke on some food or have a pulmonary embolus in my last days.

We are all part of the complex web of nature and I, for one, am consoled by the fact that when I’m gone, the universe will grind on indifferent to my bit part in its immense and meaningless pageant.

Signed………………..Date……………….

Witnessed by……………………………Date……………………………