Death – we need to talk about it. Actually, we don’t, what we need to talk about is planning the way we want to be cared for in advance of a medical emergency.

We plan for retirement by squirreling money away and making plans for cruises. We plan for the future of our loved ones by making wills. But we don’t plan for a medical crisis. We give no thought to how our wishes will be conveyed to the people treating us if we can’t speak or give time to explaining to our loved ones what our choices would be.

Recently Richard Smith, the former editor of the BMJ, caused consternation by voicing a medical view that death from cancer might be the best death in comparison to a sudden death with no time to say goodbye, a slow one from dementia or an up-and-down one from organ failure.

Medically, Smith may be correct but most people define a good death in terms of how it was managed. Was it pain free, did it occur in a place you loved, were you surrounded by family? These aren’t medical issues they are issues of personal choice – they are management issues.

All emergencies could be a little less egregious and anxiety inducing for our friends and families if we gave some thought to some basic questions. All deaths could be good deaths or, at the very least, better deaths if we all did a little thinking in advance, recording our thoughts and disseminating them widely.

In America they call this an advance directive; in the UK such documents are called advance statements and decisions.

Whatever you call them there is a library full of peer reviewed studies that show clearly that advance decisions lead to better healthcare experiences for the patient, the clinician and loved ones.

The US is beginning to wake up to the possibilities.

In an attempt to create an all-digital national register of advance decisions and statements both houses of Congress in the United States are currently debating bills that will pay every US citizen who creates an advance directive.

Why incentivise the public in a nation wedded to self-reliance? A growing and compelling evidence base.

On both sides of the Atlantic economic evaluations have shown that people with advance decisions and statements spend up to 10 days less in hospital at the end of their life. In the UK the evidence suggests a reduction of seven days.

Why? Refusal of treatment?

No. Adherence to an individual’s wish to die at home.

Dying at home costs society less and would meet the wishes of at least 70% UK citizens – but currently 50% of UK citizens die in hospital according to Dying Matters, a coalition of 30,000 members which helps people discuss dying and bereavement.

That shift in hospital usage is measureable. Less quantifiable are the savings from the bereaved carers returning to work quicker because a death or emergency was managed well. That’s before you look at reduced ambulance journeys, less use of heroic measures at the end of life and increased organ donation.

NHS England has recognised the potential of advance decisions and statements and has asked Clinical Commissioning Groups to create local registers of the wishes of people medically considered to be in their last 12 months of life.

But the Electronic Palliative Care Co-ordination System (EPaCCS) is a medical response to what should be a civic duty – an act of compassion.

An individual filling out an advance decision would be a tangible example of citizens making their voice heard, doing something for themselves, society and the NHS.

More importantly, it should be a civic duty from the age of 18 not just in the last year of life.

There is an opportunity in England, and potentially the wider UK, to create a national movement around this issue.

The act would also de-medicalise an act that is essentially about personal wishes and requires no medical knowledge. Clinicians find conversations on the issues concerning wishes difficult – so let’s take some of that burden away from the medical community and use technology to help church leaders, businesses, charities, carers and the newly bereaved to lead the debate about thinking about medical emergencies in advance.

By tapping into the compassionate community movement, marketing to the UK’s 20 million organ donors, through NHS Choices’ 20 million “unique” visitors a month and by asking GPs to raise awareness, we have the makings of a sustainable call to action.

Moreover a tool already exists to bring the movement to life and give those involved something to own.

MyDirectives.com is a free tool used widely in the US. The owners have just launched an iPhone app and the platform is already being used by hundreds of people in the UK.

The company behind the platform believes a community movement in the UK could save the NHS between £800m to £2bn a year.

At a time when the NHS is overwhelmed and is looking at a £30m deficit we need to encourage the public to appropriately take more responsibility. 2015 should be the year when millions of us take 10 minutes to think in advance how we want to be cared for to help ourselves, our loved ones and the NHS.

See Published article in the Health Service Journal:

http://www.hsj.co.uk/comment/get-ahead-and-plan-your-end-of-life-care-before-its-too-late/5078202.article#.VNToREKQinA