Reflection for a Day of Reflection

‘If only…’ must be a collective sigh as we reflect on a year of distress and separation, sorrow and loss. ‘If only we had known what was ahead…’ ‘If only we had been given a chance to say goodbye…’ ‘If only we had reacted sooner, differently, with more information…’ Regret will inevitably be our companion as we reflect.

We can use our experience to think what we could learn from the pandemic and its impact on us all. What might we do differently in future, as people we may not only be sadder but also wiser than we were a year ago?

The recent report from the Care Quality Commission about advance care planning, and in particular decision-making about cardio-pulmonary resuscitation status (read the RCGP’s response to the report), gives us pause for thought. Why was it important to ensure advance care planning was in place? For the usual reason: that each of us is mortal, and adequate advance care planning helps to ensure that we receive care in a place and at a level that is acceptable to us and appropriate for us, should we be so sick that we are dying.

Why, then, were some decisions made that could have been perceived as lacking personalisation and individual discussion? The nub of the problem: that those tender, important discussions about end-of-life care are too often postponed until a crisis arises; then the time for discussion and nuanced understanding has been lost.

The message is clear: it is time for us, as citizens and as members of families, friendship groups and communities, to talk to each other about the things that matter most to us now, and those things that will matter most when the end of our life is approaching. These discussions may be of our love of music, or nature, or pets, or dear people, and they could be life-affirming conversations that help us to distil our priorities.

Being aware of what matters most to us is also a vital first step in any medical discussions to help us understand our current and future priorities for care and treatment should our lives be under threat: how much information we would want, where we would prefer to be looked after, the balance between the quality of life we are prepared to tolerate and the length of our survival. By understanding what matters most to us, our medical advisers can help us prepare plans for our future care that are wrapped around our own, personal priorities.

This becomes even more important when a person is less able to express their priorities.

As we reflect, perhaps we might think ‘If only… If only we could engage in early, thoughtful conversations about what matters most to everyone as individuals. If only we could support people to have thoughtful and inspiring conversations with their key supporters and friends. If only we could see ourselves as mortals, and our mortality as a thing worth preparing for.’

That possibility still exists. As part of our Reflection, we can ask each other ‘What Matters Most to Me?’ We can do it at any age and stage of life, repeating the conversation as life changes and priorities shift to help us focus on what matters most – living and enjoying our lives, as fully as possible.

It’s time to talk about What Matters Most.

About the writers

Dr Kathryn Mannix is a retired palliative care physician and end of life care campaigner. Dr Catherine Millington-Sanders is RCGP and Marie clinical champion for palliative and end of life care. The article also contains contributions from members of the RCGP & Partners End of Life Care think tank.