AS A DEATH educator, I was excited to see series 1 of the American medical drama The Pitt coming to Sky TV this month.

Friends of mine in America have praised the Emmy Award-winning show, which takes place in an emergency department, for depicting death honestly.

This is unusual for the genre, so needless to say, I eagerly awaited the chance to pass my own judgment. I was not disappointed. We are quickly confronted with life-sustaining treatment decisions and their emotional toll on families and healthcare professionals alike.

We watch a family decide whether or not to follow their father’s ‘advance directive’ – known in Ireland as an ‘Advance Healthcare Directive’ – which stated what kind of treatment he would or would not want.

Now I’m interested to see how The Pitt might influence our conversations about end of life and planning ahead here in Ireland. In my role as Public Engagement Lead at Irish Hospice Foundation, I talk with communities about their options, including making an Advance Healthcare Directive.

Planning for end of life

I am asked the same questions everywhere I go. It starts with something like: “In the future, if I am too ill or injured to make a treatment decision, who will make that decision?” The best answer to that is that you can make it now, just in case! 

This is usually followed by: “What if I want something that my family doesn’t agree with?” And the response to that is that it’s your decision, but unless you have shared it in an advance care plan, then nobody is likely to know what your choices are. 

And one of the most frequently asked questions is: “How do I start these conversations without upsetting someone?” At this point, I always refer people to the resources available from the Irish Hospice Foundation, because the truth is, there’s no ‘best way’ for how you can approach this subject with those closest to you.

Navigating sensitivities

People come up to me all the time to tell me that they would love to have this conversation, but they don’t want to upset anyone. An adult child might say this about their parent, and the parent will tell me the same thing about their adult child!

Irish culture values privacy and politeness. And because of that, we are missing out on invaluable, unforgettable conversations. Out of fear of the emotional burden, we give away our say in the care and treatment we will one day receive.

Though we intend to be respectful by not talking about these things, we may end up losing the chance to respect the wishes and decisions of our nearest and dearest.

When audiences start to watch The Pitt, it’s important they know where to find the right answers to their questions. The Irish system for making these types of treatment decisions is different from that in America in many important ways. First, the decisions we make in an Advance Healthcare Directive are not suggestions – they are legally valid decisions. If I state I do not want a treatment, nobody else can override that decision.

Another difference is that we can name one person as our ‘Representative,’ a person we trust, to speak for us. This lets the healthcare team know who can consent to or refuse treatment on my behalf.

And thirdly, the Irish Hospice Foundation’s Think Ahead Planning Pack includes more than just our treatment decisions. The Personal Wishes & Care Plan lets others know how to look after us, like how to keep us comfortable, when we would prefer to be cared for at home, and what other plans we’ve made, like an Enduring Power of Attorney.

I grew up in America, where these conversations were more common. I have always known my mom’s wishes, especially what treatments she wouldn’t want. And now that she is living with advanced dementia, I’m glad she planned ahead.

I wish my mom didn’t need me to be her Attorney or her Healthcare Representative, but it’s better than making hard, emotional decisions during a crisis. She started planning long before it was needed.

Now I’m doing the same, and helping all my wife’s family to plan ahead also. Together, we’ve had meals, made decisions, signed paperwork and celebrated facing the hard stuff with wine, dessert and plenty of laughs.

I won’t give away what happens in that storyline on The Pitt. In return, all I ask is that when you and yours gather round to watch the drama unfold, take some time to ask each other the questions that matter.

Valerie Smith is Public Engagement Lead at the Irish Hospice Foundation. You can find the Irish Hospice Foundation Think Ahead Pack and useful resources on how to start conversations at https://hospicefoundation.ie/.