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Joan Rivers’ passing teaches, death is not always predictable

Death is rarely a happy event and when a favourite celebrity passes, we all mourn together. Joan Rivers passed today after a week in intensive care following cardiac arrest during what was supposed to be a routine medical procedure. “Cardiac arrest” means your heart stopped pumping blood. Without blood, cells die. If the stoppage is short enough, perhaps no damage is done, but otherwise, parts of the body begin to die. The longer the arrest, the more damage. And, the brain is the most vulnerable part of our body to cardiac arrest.

How much brain damage is too much? If I just lose the use of an arm, or lose the ability to speak clearly, I probably want to be kept alive. But, what if I’m reduced to a vegetative or minimally conscious state? Or worse?

When I litigate “end of life” cases, whether acting for a physician or the patient’s family, the probable cause of the need for litigation is failure of the patient to have had discussions with his or her surrogate decision-makers about when to say, “enough!” Some families become convinced that they are “saving” Dad when if asked, Dad would have said, “Let me die in peace with my dignity intact.” it is a highly personal decision that, failing family discussion, leaves loved ones in torment long after Dad’s passing. It is unfair both to Dad and to his family.

While these are difficult conversations for a lot of people to have, not having them opens the prospect of having to make far more difficult decisions without all available information. The simple fact is, your loved ones won’t know your wishes, values and beliefs unless you tell them.

And, as Ms Rivers’ passing teaches, death is not always predictable. Perhaps you should honour her memory by using her death to open this conversation with your own family?

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