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Dignity and Final Wishes

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page A10 in the April 7, 2010 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

At a time when more people are choosing to die at home, just how we deal with death is evolving into an unspoken concept in our society. Death is one of the only centainties in life. Death, as a way of celebrating and respecting the cycle of life, is very important. Many people feel that the sheer mention of death is tempting fate. We glorify medical breakthroughs and reinforce the notion that no matter how hopeless a situation, medical science will guarantee extension of the life process. We anticipate the death of our elderly will always occur in a slow and controlled manner with plenty of time to make choices and arrangements.

We all hope that the transition from life to death occurs quickly. In my role as a coroner, I frequently encounter distressing situations in which family members are expected to make final decisions for their loved ones. These decisions are fraught with guilt if prior intentions are left unknown. I encourage everyone to think and discuss your wishes, make a will and decide how your memory will be honored.

Medical science has not altered the cold reality that anyone over 60 years of age who sustains an unwitnessed cardiac arrest has little chance of prolonged survival. Even with a rare successful resuscitation, survival is measured in days to weeks. Calling 911 when an elderly, deceased family member is found under normal circumstances is a common reaction. It ties up valuable police and fire resources, and is better used for a medical emergency for the living. Coroners only investigate when there are suspicious circumstances surrounding a sudden and unexpected death. The investigation can cause anxiety and grief for those involved. Often the deceased is left where the body is found to aid the investigation.

Several myths abound around the death process. Many people afflicted with terminal illnesses choose to die at home. We are blessed with a palliation program that brings health professionals into the picture and often results in a dignified transition. There is no rush to move a person after death. In many cultures, the deceased remains at home, from where the funeral rites take place. Time allows for family members to arrive, pay respects and gain a sense of closure.

Death must be pronounced by a delegated nurse, paramedic or physician. A death certificate needs to be issued within 24 hours to allow burial or cremation. In expected deaths, it can be filled out, but not signed ahead of time. There is a common fallacy that the body cannot be moved without the certificate. Not true, since the death certificate is used to register the death. The body must be moved in a respectful manner. Funeral arrangements can be made professionally through a funeral director. It is possible, although not recommended, to do it yourself. If you are caring for a relative with failing health, I urge you to talk about his or her final wishes, and to discuss how to recognize death and what needs to be done when it occurs due to natural causes.

Ever wondered what medical school is like? This spring, you have a chance to sample it, with a series of lectures at UTM (University of Toronto Mississauga) open to the public. I will be a guest lecturer and hope to provide you with some forensic anecdotes. Visit Mini-Med School at the University of Toronto to register.

Related resources:

Professor brings med school to the masses by Susan Poizner, Special to The Toronto Sun.

When Someone Dies - Why do I need a Death Certificate? From Government of Ontario

What to Do When Someone Dies from the Government of Ontario

Provincial Vital Statistics Offices - Across Canada from the Government of Canada

Coroner from Wikipedia, the free encyclopedia.

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