Your life has a plan. Your death probably doesn’t.
If you’re in your mid-life years, you have probably made some sensible, grown-up future life decisions like life insurance, critical illness cover and pensions. So why don't we plan our death?
Let me guess, if you’re in your mid-life years, you have made some sensible, grown-up future life decisions like life insurance, critical illness cover and pensions. Christ we even meal plan and plan what we are going to watch on Netflix that evening, but do we plan our death?
In my decade of working as a GP, it’s the one plan that many hope they won’t need, but it’s the one guarantee in life. We are born. We die. Everything in between is optional, negotiable, or wildly unpredictable. Yet somehow, we’re very comfortable planning for all the “what ifs” in the middle, while steadfastly avoiding the one thing that will absolutely, unquestionably happen.
I’ve been paying into my pension since my first doctor’s payslip landed. Life insurance became another tick-box the moment I acquired a mortgage and a concerning level of debt. But a plan for increasing the chances of a dignified death? That’s the bit most of us quietly sidestep. In primary care, we call this an Advanced Care Plan or ACP, because even death needs an acronym!
Advance care planning is about thinking ahead while you still can. It asks you to consider what matters to you before you lose the ability to make those decisions yourself. Ask yourself what is important to you, is it being as comfortable as possible, more time with your loved ones, receiving spiritual support, and/or being in your own home in the last stages of life? It’s useful to discuss these wishes not only with your loved ones, but with your healthcare providers also, so they can understand you and what you would want in different situations. Advance care planning also allows you to choose someone you trust to make medical decisions for you in the future if you lose the ability to do this for yourself (a lasting power of attorney for healthcare needs).
What advanced care planning is NOT;
- It is not just for very old or very ill people
- It is not the denial of medical treatment
- It is not euthanasia
- It is not just about death
More terminology;
- Euthanasia: A doctor intentionally administers a lethal substance to end a patient’s life, usually at the patient’s request, to relieve terminal suffering.
- Assisted Dying/Suicide: A healthcare professional provides the means (e.g., medication) for a patient to self-administer, enabling them to end their own life.
- Palliative Care: A group approach to care for people with serious, life-limiting illnesses. It focuses on symptom control and comfort without hastening death.
Ok, it may feel a bit premature to be making these decisions for yourself right now, but sadly accidents and sudden illnesses can affect us all, so would it be useful to at least start thinking about them, especially if you know you have strong preferences regarding your health. And then there’s the bigger question: have we had these conversations with our ageing parents or loved ones? Many of us haven’t. Let’s start normalising these conversations. I know it can be awkward, often sitting in the same FML mental folder such as tax returns, those tasks that you postpone to ‘later’ but it’s healthy to chat it through. Advanced care planning does not only refer to planning a dignified death, but if a patient/family member has complex or multiple healthcare needs, it’s also about planning care that reflects their values and improves outcomes while they’re very much alive.
In England, less than 15% of palliative patients (i.e. someone with a serious, life-limiting illness) have advanced care plans. For non-palliative patients, the figure is almost certainly lower. As a profession, we could be far better at normalising these conversations in primary care, but discussion around death still carries a taboo that makes everyone feel awkward.
Approximately 500,000 people die in England each year. That means about 1% of the population will die annually (I like easy figures these days, mental arithmetic is a last century thing now, isn’t it?) With a GP practice list size of 10,000 patients, which is the average practice size in England, there will be a 100 patient deaths per year. It is thought that approximately 75% of these deaths are expected so these conversations should be taking place with at least 75 patients/year, and we are usually good at identifying this cohort of patients and creating advanced care plans with them. But what about the people who should be on our radar who are not? To address this, GP practices have started running background searches to identify patients who are likely to benefit from these discussions. NHS England’s EARLY toolkit helps flag people who may be in their final 12 months of life, those with frequent GP attendances, multiple hospital admissions, recurrent falls, moderate to severe frailty, or cancer progressing despite treatment, to name a few. These conversations need to happen more often, earlier, and as a routine part of medical care, not as an afterthought. We all NEED to normalise these discussions.
In June 2025 an ‘Assisted Dying’ bill was passed in the house of commons. It is currently under scrutiny in the house of lords, who are reviewing many amendments to the bill. The deadline for this is May 2026 for the bill to be passed, and it’s looking unlikely that the deadline will be met. This bill proposes that adults who are terminally ill, mentally competent, and have 6 months or less to live should have the option to choose assisted dying (whereby a medical professional provides the means for a patient to end their own life). It includes several safety measures:
- Exclusion of people with disability or mental illness alone unless they are terminally ill
- Ongoing assessment of mental capacity
- Full discussion of all alternatives, including palliative care options
- Independent confirmation by two doctors, with specialist input if required
It makes me wonder: if we normalised talking about death, if we gave advance care planning the same attention we give pensions, insurance policies, and five-year life plans, would we even need an assisted dying bill? If healthcare professionals had more time, and were more proactive in having these conversations, and if patients and families were more forthcoming with discussing these topics with their GP, could we improve palliative care and reduce suffering at the end of life?
For now, I’ll leave you with these two quotes….
“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.” - Dame Cicely Saunders (Founder of modern hospice/palliative care).
“Advanced care planning isn’t about predicting the future, it’s about sparing the people you love from having to guess.” - Ellen Goodman, a Pulitzer Prize-winning journalist and founder of The Conversation Project
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