Liam Farrell: A different approach to an advance care plan

Joe looked unusually pensive, which cheered me up a bit and added some sparkle to the morning.

‘Your native hue of resolution / Is sicklied o’er with the pale cast of thought,’ I observed.

‘I was wondering,’ said Joe, ‘if I should get an advance care plan in place.’

I was a bit surprised by such a display of forethought, by this first intimation of mortality, the first falling leaves of vulnerability; Joe has always been a man who demanded immediate gratification of all his desires, his only forward planning on the lines of how big a steak to eat tonight, or the most likely winner of the 3.30pm at Kilbeggan today.

But I did have sympathy for his request; no one is allowed to die peacefully anymore, instead we get tubes rammed down our throat, multiple needle jabs, our shirts ripped off and electric shocks administered – and all of it a very public spectacle, as an audience has become traditional.

Everyone means well, of course; what could be more meritorious than bringing someone back to life? But as Albert Camus said: ‘Good intentions may do as much harm as malevolence if they lack understanding.’

‘So what would you like in your advance care plan?’ I said. ‘I can give you a form with all the information.’ I love giving out forms, it saves me having to explain every bloody thing myself, like I don’t have, you know, a life.

‘Most important thing,’ he said. ‘I want a big flatscreen TV, with Sky Sports, the Racing Channel and Netflix.’

‘We may have a slight misunderstanding here,’ I said. ‘An advance care plan is a legal document in which you specify what actions should be taken for your health if you are no longer able to make decisions for yourself. We should all have one signed and filed, to avoid having some big sweaty guy pounding gaily and unnecessarily on our chest. But what the it will not specify is having a big TV in your room.’

Joe was undeterred by such minor details.

‘When I’m dying,’ he insisted, ‘I want a big TV; pull the plug on me before you pull it on the TV.’

He gripped my hand urgently and looked me straight in the eyes.

‘Can I trust you to do that for me, doc?’ he said. ‘Can I trust you not to pull the plug?’

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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