The death of Queen Elizabeth II has the potential to teach us something about how to die. The late Queen's death is a helpful example of ordinary dying, the physical process of the body slowing down. In her later years the Queen gradually adapted to frailty – she travelled less and rested more, she delegated some duties to others, she conserved her energy. Mannix (2022), in a thread on Twitter, described how the death of the Queen would fit with the concept of ‘ordinary dying’ that has been used in health and care settings for many years. It refers to the modern dying process, where the person's symptoms are well controlled and the individual dies peacefully. However, those who are dying, as well as those caring for them, may not expect this ‘ordinary’ death and as such they may not recognise this as normal dying (Mannix, 2022).
There were elements of the Queen's death linked to the ideal of a ‘good death’. A death that is planned, with family present and in a location the person enjoyed being in. Within the sphere of palliative care, dying is as much a social event as it is a medical one (World Health Organization, 2020).
Who decides what becomes an ‘ordinary’ death and how this is this enacted are key questions, as well as how a person ‘should’ die or what is called a ‘good’ death. Answers to these questions will shape outcomes. As well as caring for patients and families, there is also a need to care about the processes that lead to an event. By ensuring that the person's best interests are paramount, this can lead to a good death. At the end of our lives, we can still enjoy love, peace and friendship.
Advance care planning is a voluntary process, involving person-centred discussions taking place between an individual and care providers regarding their choices and priorities for future care. When advance care planning is undertaken with kindness, competence and confidence, people can feel more confident that care and treatment will be centred on what it is that matters most to them in a personalised, holistic way, helping them to live as well as possible (Universal Principles for Advance Care Planning Coalition, 2022). The Universal Principles for Advance Care Planning sets out six high-level principles for advance care planning in England (Universal Principles for Advance Care Planning Coalition, 2022). These focus on the person being central to developing and approving their advance care plan as well as deciding who else should be involved. Personalised conversations on what matters to them and their needs, and a shared decision making process in partnership with relevant professionals, result in a shareable advance care plan. The person is encouraged to review and revise the plan and those involved in planning can speak up if they feel the universal principles are not being adhered to. The overall aim is to unify the approach to advance care planning conversations, including ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions, ensuring people are supported as partners in their personalised care, across health and social care systems.
When there is a consistent national approach to advance care planning this enables people, their families or representatives, clinicians, professionals and workers to share the same understanding and expectations of advance care planning. Planning for future care can be an empowering act, permitting people to feel confident that their wishes will be respected if they are ever unable to fully take part in decision making. Having good-quality conversations about future treatment can instil in people a greater sense of control over their ability to live as well as die well. Nurses are very often key stakeholders in these important conversations. Implementing clear and consistent best practice across all care settings ensures everyone experiences the personal care they deserve, delivered in a compassionate way with positive conversations about important decisions. These are key components of good quality advance care planning, applicable to all.