A touching and important blog deserves close reading, though have a tissue near by.

It’s from Dr Kimberly Manning, who works at Grady Memorial Hospital, Atlanta Georgia. In it she describes how and why the decision was made not to prolong unnecessarily the life of one Mrs Cafferty and how it was accepted by her family, there at the hospital by the side of the dying woman.

When challenged by a colleague why the medical team shouldn’t do all they could to keep this patient alive, Dr Manning replied: “Mrs Cafferty is dying.”

The blog continues: “I stated the facts and left it at that. In silence, it set in. I could see their wheels turning. Imagining those same things that I was thinking like, Why are we sticking her with needles and pricking her fingers for blood sugars when those things hurt? Why are we not focusing on keeping her as comfortable as possible?

“We entered her room that morning and…discussed these things with the family. By this point, Mrs Cafferty was lapsing in and out of consciousness, so this conversation took place with her children. And no, this was not the first time that the subject of end-of-life care had been brought up with them, but it was the first time they were ready to accept what was happening.

“ “Let her go in peace,” the eldest daughter finally said. “This is our decision. Mama would not want us to keep her alive this way. Please just keep her comfortable.” The rest of the family nodded in sombre agreement.”

Why this is important is that it describes a changing of a mindset that assumes the medical profession should do all it can to keep someone alive regardless of the diminution of quality of that life, to one where the futility of such intervention leads to its withdrawal. And so, with the informed consent of the family, medical treatment is ended so that death can come naturally, with no more tubes, chemicals, machines or doctors’ valuable time used to delay the inevitable.

In short, society and the medical profession are beginning to believe that while the prolonging of life is accepted as a medical absolute, to prolong death is a futile, cruel and costly perversion.

To make this changing view of medical practice more acceptable, it’s essential that people have their individual death plans, filled in following discussion by the ailing patient, their close family, their medical professionals and if appropriate a minister of religion.

My Last Song has created a holistic death plan that covers the medical, physical, emotional, spiritual and practical issues, even down to who looks after the pets. It includes considerations such as the aromas the patient wants to smell, music to hear, people to be present, where the patient wants to end their life and, of course, the level of medical intervention.

Its aim is to make the end of life as comfortable and comforting as possible.

The easy to complete template can be found in the Lifebox section of My Last Song. Once filled in, it can be securely stored, updated and accessed by selected loved ones so the end of life experienced by the dying will be one supported by those like Dr Manning who have the quality of their patients’ lives foremost in their minds.

I was very encouraged to read this excellent blog by Gail Ruben.

Gail runs A Good Goodbye out of Albuquerque, New Mexico.

Its strapline, which appeals hugely to the My Last Song team, is ‘Funeral Planning for Those Who Don’t Plan to Die’. We have two straplines which benefit from greater brevity but lack the clever humour. They are: ‘Plan Your Exit Strategy’ and ‘A Good Life Deserves A Good Ending’.

Gail’s blog looked at what she loosely titles funeral films, and then describes the great music played in the soundtracks.  Quite a few have been chosen by visitors to Family Bhive in their fave five – the five songs they want to be remembered by, or played at their funeral, or send off party. Several haven’t yet been chosen but should be listened to because they are  excellent farewell songs.

What was encouraging was the confirmation that there is  a growing interest in the importance of getting the right music played at your farewell, rather than clichéd hymns (and I recognise how important hymns are for those of the Christian faith) and even clichéd secular songs.

My Way comes top of those songs that show little imagination. There are better Frank Sinatra tracks, even though Paul Anka’s lyrics are very apt for the final review of a life about to end.

In the past few months there have been increasing number of online forums, mainly in the US, Canada and UK, discussing funeral songs. The range of suggestions has been vast, covering most modern music genres, as well as arias and classical pieces.

Anything which makes people think about their mortality and plan to make it as positive and successful a goodbye as possible should be encouraged. That’s why we are part of the Dying Matters coalition here in the UK and want to share information and ideas with people like Gail Ruben in the US.

Two encouraging developments today. The first here in the UK, the second in the US.

In the UK, the excellent website Gransnet, founded by Justine Roberts who previously set up Mumsnet, posted a forum on whether photographing funerals was acceptable. I’m a great fan of Gransnet, not least because of the wisdom and eloquence of its editor, Geralding Bedell. Other good things about it are the general common sense and progressive views of its members and visitors and its use of social media including twitter.

I used twitter to point out that funeral photography was a growing trend, and linked to articles on My Last Song by Priscilla Etienne and Rachel Wallace, two excellent funeral photographers. Hopefully Gransnet twitter followers will consider the benefits of commissioning either of these photographers the next time they have to organise a funeral, which I also hope is not for a long time.

In the US, Carolyn McClanahan contributed a thoughtful piece to Forbes, I’ve Accepted I’m Dying. Now What? This was as good a description of why I started My Last Song four years ago as it’s possible to get.

It urged people to plan their funeral in advance, work out the probate, put their financial affairs in order and leave their memories, wishes, life stories for others to share, in the form of specially recorded videos.  This is an endorsement for the My Last Song Lifebox idea, and Carolyn hadn’t come across My Last Song when she wrote this piece.

I commented, repeating my support for her views, namely a good life deserves a good ending…but it has to be planned.  Carolyn immediately replied that the problem was getting people to ‘do it’.

And she’s right…death, dying, our mortality, our funerals are the most difficult subjects to discuss and plan.  My blog yesterday argued that if the reason for discussing death was to have as good an ending as possible, the discussion might just be more approachable.  The vehicle for this discussion would be the filling in of the ailing person’s death plan. It makes sense to me, but there again it would…I created the death plan template.

Hopefully Carolyn McClanahan will see the benefits of a death plan and write about it in Forbes.

There’s probably no harder conversation to have with anyone than to tell them they are dying, or that they should consider their death. Indeed so difficult do many people find it that it’s never broached. The reluctance is understandable, discussing a person’s death is likely to cause upset or raise suspicions.

So we take the easy way out, and the end of life decisions are then made for the dying patient rather than by the dying person. Hence the medical professionals will assume that the family expect medical intervention.

Family members too will take decisions, usually confirming the doctor’s view that they want prolonged medical intervention so their loved one lives longer.  Some will decide they haven’t the ability, facilities or inclination to care for a dying loved one and so the person whose life has run its course is left to suffer unnecessarily prolonged intervention in a frightening and often lonely hospital.

Very few medical professionals or close loved ones will think about the sensory elements of the dying person’s end of life experience. Where do they want to die? Who do they wish to be present, or not present? What do they want to see – photos of loved ones, lovely views?  What smells would they like to experience as their life ends? Do they want their hands held, to be caressed, to be massaged?

They will, of course, want to be rid of concerns, so issues such as their funeral wishes, their probate, and the care of their property and pets, should be dealt with in advance so they can ‘die in peace’.

The Royal College of Physicians’ report that recommends that doctors are regularly trained on communicating end of life treatment with their patients is clearly limited to their role in providing suitable end of life treatment. Quite rightly, they see the need for planning for the death well in advance in the hope that patient and doctor have a meaningful discussion. The palliative care, which should extend to the spiritual and physical, will be limited to the medical.

My Last Song believes that by having a personalised death plan, the medical decisions and the existential decisions can be discussed and agreed at the same time, with the involvement of the patient, the medical professionals, loved ones and if appropriate ministers of religion.  We’ve created a death plan template to make it as easy as possible to fill in, edit and save.

The result should be a more comfortable and comforting end of life experience, and if this is the likely outcome, then the discussion is less difficult to initiate, less likely to be misconstrued.

On Mother’s Day we think about, of course, our mothers.

They brought us into this world, nurtured us, educated us, paid for us and still play a big part in our lives.  For those whose mothers aren’t alive, their absence often highlights how much we loved them because we miss them and their love for us all the more.

So with Mother’s Day only two days away, consider the virtues of buying your mother a Lifebox.

This is a specially designed and easy to use secure online storage area in which her digital memories, images, videos, music, wishes, achievements can be stored.  If she’s not confident with computers, then younger members of the family can help her, which will increase the bonding between family members of different generations.

Populating the Lifebox with her memories, names of her friends and relatives and her life story means personal family and social history is captured that would otherwise be lost forever.

It also means that your mother will feel valued and pleased that the family want her memories to be accessed and read for generations to come. And you and your offspring will also find reassurance and happiness in opening her Lifebox from time to time to know more about her, her life, her achievements, her dreams, her wishes.

You will also find it useful too as it will encourage her to write down her final wishes and the information the family will need when she eventually passes.  Okay, this might seem shocking, but it’s far more shocking when nothing has been planned, nothing decided and the details you or the executor is lost or difficult to locate.

But to stress the positive…how wonderful that by having her Lifebox, your mother’s memory will live forever.

I’ve had enough of The Spectator. I know it’s difficult to bring out a weekly magazine with relevant and high quality articles, but there ought to be a higher bar than the silly ranting of Stephen Pollard, whose observation of the audience booing of Dvorak’s Rusalka at the ROH has the strapline: ‘The British no longer know how to behave in public’.

A cruel, or stupid, sub-editor highlighted the crassness of Pollard’s piece by selecting this statement as the stand out: ‘Now that going out is as easy as staying in and watching TV on the sofa, we behave when we’re out as if we are watching TV on the sofa’. Clearly Pollard hasn’t tried to reach or park in theatreland in the past ten years, but why let facts get in the way of a space filler.

Rod Liddle fills his space with a daft piece that argues the falling support of right wing racist parties will result in a rise in racial violence because bigots and fascist thugs need an outlet for their anger.

Lucy Bannerman writes just about the only worthwhile piece, reporting on Zambia’s achievement of changing goverment peacefully after last year’s election – fairly rare in Africa – and the appointment of a white man as vice President – understandably an exception in post-colonial, post-apartheid Africa.

James Delingpole, who a few weeks ago contributed what was virtually a press release praising the children’s book The Hunger Games, this week attempts a critique of Quantitative Easing, equating it with Soviet style planned economic policy.  He fails, not least because he admits that he isn’t an expert in this area. Is there, readers probably wonder, any area on which Mr Delingpole is an expert?

In the Arts section, it goes without saying the reviewer, Andrew Lambirth, is taken in by Cy Twombly’s scribbles.  This sentence confirms the reviewer is a fool. “Looked at in one way, it’s only a bit of scribble. Differently angled, it’s a rough chimney shape in blue crayon with five dabs of pink oil paint and three further touches of pink.” So it doesn’t matter which way you hang it up were you daft enough to buy it.

But why I won’t read another copy of The Spectator is the insert, The Spectator Guide to Independent Schools.

The publisher  of, and contributors to, The Spectator are too myopic to realise that private education, available only to privileged children, divides and perverts our society. Unimportant to them that the guide is full of fluff such as the importance of going to open days to see if a private school is worth the money, which schools specialise in sport, why one writer enjoyed his private school days as an army cadet, and the most absurdly self indulgent and banal piece by James Delingpole (yes, him again) justifying why he sent his son, whom he calls ‘Boy’, to Papplewick, a school in, where else, Ascot.

‘Boy’ was boardered there because it had a snake club, and when taking his son round on the open day, the inane Delingpole senior was hit on the chin by a rearing and understandably annoyed snake. ‘From that moment on,’ he says, ‘ I knew this was the school for Boy.’

‘Boy’ apparently asked his parents during the tour: ‘Might I really be able to come here?’ Anywhere rather than staying in the company of his pompous father would be a considerable relief to ‘Boy’, one suspects.

The adverts from these wretchedly unrepresentative educational establishments in the guide may subsidise The Spectator, but it now has one fewer reader.

This morning, Dr Margaret Evison, the mother of a soldier killed in Afghanistan in 2009, was interviewed on The Today programme in the aftermath of the death of the six British soldiers. This brings the number of British service personnel killed in Afghanistan to 404.

Dr Evison said that when she visited the country two years ago her thinking about the cause for which her son died changed. The social pressures as well as “the revenge culture” and the physical size and layout of Afghanistan made her doubt if the war was winnable.

No war waged by foreign forces in Afghanistan is winnable. Experts in the Foreign Office will have stated this to Tony Blair and Foreign Secretary Jack Straw, pointing out not just the lessons of history but that the current situation with the country divided into competing ethnic groups, tribes, warlords, bandits, Islamic extremists, run by an unpopular, ineffective and feeble central government, and with Pakistan, Iran and other neighbours intent on destabilising it would result in heavy casualties inflicted by a fanatical, invisible and, in some areas, popular force called the Taliban.

They would have told the politicians that the Taliban, the religious extremists and warlords would fight any moves to impose external values and culture with deadly effect. They would have dismissed the notion that an external force could defeat the Taliban, build a coalition to govern democratically or change a culture so embedded and so utterly different to ours.

Blair and Straw had commited to helping the US to invade Afghanistan and ignored the advice. Eleven years later and 400 plus brave, loyal and never to be forgotten deaths later (as well as thousands of innocent Afghans whose deaths have made the country’s hatred of the west far more intense) we are pulling out with our tails between our legs.

Let’s hope that our abject military and political failure in Afghanistan and the abysmal achievements of overthrowing Sadam and Gadhafi (Iraq and Libya now destined for years of bloody division, settling of scores and slaughter of innocents while Iran, Saudi and Israel fight proxy battles) prevent the west from considering any further military interventions in either Iran and Syria.

There are few certainties in politics or international affairs but the following is one of them: “The aims and objectives of external intervention in totalitarian Islamic countries will never be achieved, and instead intervention will make the situation more unstable and dangerous.”

Coffins are going through a change of image in our culture, though an understandably slow change because everything to do with the subject of death and dying is conservative, whether the funeral industry (though with notable exceptions) or our society…you’re likely to be in a group of one if you ask people at a party if they’ve thought about their coffin recently.

Risking, then, online isolation, let me point to the popularity of the display of Ghanaian and English ‘designer’ coffins at January’s South Bank exhibition on death, and also to the growing trend for decorating coffins of loved ones with bespoke designs, graffiti, illustrations, words of affection and humour, even glued on newspaper cuttings and photographs of footballers and pin ups.

I’m all for this trend as it will make people think about the choice of coffin, rather than nod through what the funeral director suggests as the price of the coffin makes up a large part of the cost of the funeral.

I’m particularly exercised by this issue because the cross on the back of Bernard’s coffin was incongruously facing an almost exclusively atheist group of mourners throughout his humanist funeral.

On a range of costs you have at one end the elaborately built coffins much loved by some Ghanaians and the wonderful Crazy Coffins, to the plain cardboard coffins that will be supplied direct to the family from companies such as Greenfield Creations.

I believe that the involvement of bereaved loved ones, or those facing bereavement, in choosing an appropriate coffin (such an eco-friendly type if the departed was concerned with the environment) and decorating it with personal images and messages, can reduce the feeling of helplessness, anxiety and anguish that death inevitably causes.

Playing a part in personalising the coffin is a way of saying that you accept death and aren’t going to collapse into grief when confronted by it. So, I’ll risk telling my friends and fellow party goers that the next time I’m involved in a funeral I’m going to decorate the coffin.

It might clear the room, but at least I’m doing my bit to change our culture. (Probably why the last time you were invited to a party was five years ago – ed.)

Time to fess up…’Harry’ is Bern, aka Bernie or Bernard, Shaw. His funeral yesterday was a success if defined by the emotions expressed by those who attended.

Funerals will only be ‘successful’ if properly planned and that takes time and effort from those involved.  The funeral director, W Uden, did a good job, though commissioned by Bern’s sister Joy and his best friend Bill, so I can’t speak for them but everything was agreed and delivered according to plan.

They recommended an excellent humanist celebrant, Jeanne Rathbone, who put the ceremony in a humanist context, understood and related Bern’s positive characteristics and personality and outlined the key events in his life without diluting the tributes that followed. She was most sympathetic and respectful, especially when relating Joy’s reminiscences of their childhood together.

Jeanne also augmented the readings by reciting two appropriate poems, If I Should Go by Joyce Grenfell and How Long Is A Man’s Life? by Brian Patten.

West Norwood crem (see note at the end) doesn’t use the Wesley Music system for playing farewell tracks, so I recorded a CD  with the music for the ceremony.

The tracks were played absolutely on cue by the crematorium manager…Bernard came in to Space Intro/Fly Like An Eagle by the Steve Miller Band. My tribute – memories of our friendship and his unique qualities – ended by detailing some of the music we shared. This included Tom Waits, and so was played his tender, anguished version of Somewhere, from West Side Story.

Then Bill, a loyal and generous friend of Bernard, recalled two or three very humorous moments they shared when Bern stayed with him following his time in Frankfurt. We needed some laughter and Bill delivered.

Hilary, Bern’s partner for an intense period many years ago and who, like many others, has stayed loyal and affectionate, read most sympathetically The Road Not Taken, by Robert Frost. This was chosen by Maggie, Bern’s widow who came over from Frankfurt to attend.

Maggie was deeply affected by the funeral and hugely grateful to all those who attended. She designed the excellent order of ceremony leaflets, using some great photos of Bernard.

The track played during the time for quiet contemplation was Meadow of Delight and Sadness from John Barry’s lovely The Beyondness of Things.  And as we watched the curtains close around Bernard for his final journey, The Joker by the Steve Miller Band played, understood and appreciated by everyone who had cried tears of laughter when Bern told a joke or acted out a ridiculous monologue.

Virtually all came back to The Rosendale to share memories, catch up on old friendships and listen to a playlist to which various friends contributed. The staff were helpful, the food excellent and the music system worked well. More important, it was good to meet members of Bern’s family who attended and whose memories of Bernard were so touching to hear.

Bernard, I’m glad to say, had a good funeral. Several people said he would have approved. On his behalf, then, thanks to everyone concerned. Continue to remember him well.

West Norwood Cemetery is an excellent example of a Victorian metropolitan lawn cemetery and has the finest collection of sepulchral monuments in the capital, including a dedicated Greek Orthodox necropolis. Lambeth Council built the crematorium on the top of the hill from which there’s a great view of London. I recommend it as a peaceful and interesting stroll.

A survey on people’s end of life wishes carried out by the California Health Care Foundation in late 2011 came up with the following findings:

67%: Making sure family is not burdened financially by my care;
66%: Being comfortable and without pain;
61%: Being at peace spiritually;
60%: Making sure family is not burdened by tough decisions about my care;
60%: Having loved ones around me;
58%: Being able to pay for the care I need;
57%: Making sure my wishes for medical care are followed;
55%: Not feeling alone;
44%: Having doctors and nurses who will respect my cultural beliefs and values;
36%: Living as long as possible;
33%: Being at home;
32%: Having a close relationship with my doctor.

The Foundation, in summarising the findings, says that there’s “a disconnect between what Californians want (a natural death at home) and reality.” The various poll answers, available in the pdf, prove this conclusively.

What’s true for Californians is true for older people in this country too, and in most developed nations facing the same issues of increasing numbers of old people, the taboo around discussing dying and death, and medical advances which make prolonging life in hospital more likely than a natural death at home.

So, how to make the end of life experience less a ‘disconnect’ with what people want and more a positive, comfortable and comforting experience?

Well, encouraging ailing older people and the terminally ill to have a personal death plan would be a great step forward. It would enable the patient, their loved ones, their medical professionals and, if appropriate, their ministers of faith, to discuss openly and honestly the end of life experience the patient wants, and if at all possible, deliver these wishes.

We have created a holistic death plan that covers the medical, physical, emotional, spiritual and practical issues, even down to who looks after the pets. Less prosaic are considerations such as the aromas the patient wants to smell, music to hear, people to be present, where the patient wants to end their life and, of course, the level of medical intervention.

If the adoption of death plans became widespread, far more people would have the end of life experience they, and their loved ones, want.

To make it easy, there’s a simple to complete template in the Lifebox section of My Last Song. Once filled in, in can be securely stored, updated and accessed by selected loved ones.

The more people who have their death plans, the more seriously they will be taken by the medical profession.