Dying at Home
My mother wants to die at home. What do I do if there’s a serious emergency?

Having your mother’s wishes outlined on paper will help both of you. If you know more about what your mother really wants, you’ll be assured that you’re following her wishes in an emergency, rather than making decisions for her. While the name and purpose varies across the country, most areas of Canada recognize health care directives, also known as advance directives. It can be written by a patient or a lawyer, as long as it follows the procedure required in each province or territory. It’s used to guide decisions if the patient can’t communicate in any other way. The document can also name a person, called a proxy, who can make decisions on the patient’s behalf.

A directive can be general or specific. It can state that someone doesn’t want to be kept alive against his or her wishes, or it can state that someone wants all possible treatments within generally accepted medical standards. It should provide for appropriate pain control, comfort care and respect for the patient’s dignity.

For your mother, it’s important that a directive states that she wants to die at home. It’s important also that it specifies how she wants to be cared for in certain circumstances. For example, it can state whether she wants cardiopulmonary resuscitation (CPR), a ventilator for breathing, or other treatments. In preparing a directive your mother may find it useful to talk with her health care team about the benefits and risks of specific treatments. If your mother names a proxy, she must ensure that the proxy knows her values intimately and understand her wishes. The proxy may become her spokesperson, interpreter and advocate.

In most areas, a directive has no legal effect if your mother can still make her own decisions. Health care providers can’t ignore what she says in favour of written instructions. They need her consent for treatment if she’s capable of giving it. If she can’t, then health care providers are legally obliged to follow instructions in a health care directive if one exists. Therefore, it’s a good idea that key people have copies of the directive. This may include family members, health care team members, and especially the proxy who may need to act on her behalf. Some patients carry their own copy at all times and leave a copy with their lawyer.

If your mother has a stroke or heart attack, and 911 is called, things can become complicated. If your mother dies suddenly, and doesn’t want to be resuscitated, you may want to avoid calling emergency services. Paramedics generally are required to resuscitate and stabilize patients until they’re brought to a hospital. If paramedics are told about a health care directive and it addresses this scenario, then they’re legally obligated to follow it. A directive makes it more likely that your mother’s wishes will be respected.

If your mother doesn’t want to be resuscitated, it’s important to make sure everyone in the family knows this. People can panic in emergencies and it may be hard to resist calling emergency services if she dies suddenly. The impulse to call 911 may be redirected if you’ve made different emergency arrangements beforehand. This can include having a health care provider agree to visit when your mother dies, and arranging to have your mother’s physician write a letter to the medical examiner’s office. In areas where certain deaths need to be reported, the letter gives notice of the likely circumstances of a death. Then, when your mother dies you notify your mother’s physician or nurse, and call the funeral home when you’re ready. The funeral home will then pick up your mother’s body.

If your mother wants to stay at home to die, plans can help make it happen. Even with a plan in place, though, people can react unpredictably in the face of death. If there’s a directive in place it can help keep the focus on your mother’s wishes, even in an emergency.

Considerations for a Home Death