SUPPORT
MATTERS OF LIFE AND DEATH
Kevin Flemen
confronts a topic we
all need to talk about
A
few years ago, on a
training course we
started to discuss
death. Surprisingly
this wasn’t on the
drug-related deaths course, where
such discussions could be expected
to take place.
This was on an NPS course,
and the conversation related to a
worker struggling with a young
person whose high-risk polydrug
use and apparent unwillingness
to take on board harm reduction
measures left the worker
desperately worried and stuck.
We discussed the idea of the
young person writing a ‘what if…’
letter to their parents. ‘You think
you are going to be OK,’ the worker
said. ‘And hopefully you will be. But
if something bad happened, maybe
you might want to write a letter to
your parents now. Just in case. You
can leave it with me, so I could pass
it on to them.’
Further down the line, the
worker got in touch saying that
after having this discussion with
the young person they came in two
weeks later, saying that they hadn’t
used at all. The enormity of sitting
down with a piece of paper saying
‘Dear Mum and Dad, if you get this
then…’ was, for this young person, a
catalyst for change.
While my initial interest in this
18 • DRINK AND DRUGS NEWS • APRIL 2020
may have started with discussions
around risk and mortality as a
part of motivation, it isn’t now
my primary interest. Instead it’s
the realisation that drugs workers
should be discussing the risk (and
ultimately the inevitability) of
death far more than we do.
Drugs work is fundamentally
an optimistic occupation. It seeks
to reduce harm, reverse overdoses,
promote and achieve recovery, help
people reach their turning point, to
change and grow, to rise phoenix-
like. But people can, do and will
die. Some very prematurely, some
less so. In our optimism what
discussions can, and should,
we have with our clients about
mortality? How do we balance
these discussions (which could be
considered pessimistic) with the
need to inculcate our services with
positive messages of hope?
Many people who use drug
services are isolated from family.
They may not have close contact
with ex-partners, their children,
siblings or their own parents.
Obviously this won’t be true for all,
but it’s painfully true for some.
This isolation may be
compounded by professional
isolation – limited access to
GP care, recurring episodes of
homelessness, transience, periods
of incarceration.
Given this personal and
professional isolation, drugs
workers can have a key role in
representing a person’s wishes and
intent regarding end-of-life care
and their death.
For example, has the person
considered their wishes in terms of
advance decisions (living wills)? If
they’d overdosed, been deprived of
oxygen and could be maintained
on a ventilator, what would they
want? Has anyone asked them?
Has it been recorded anywhere?
Beyond these discussions, does
the person want to write and
lodge letters for estranged family
or friends? Have they considered
writing a will if they have
possessions they wish to pass on?
How do they want their funeral to
be conducted?
For some people these
conversations will be much more
‘what if…’ They could take place
with people who have significant
risk of overdose, or who had
recently experienced and survived
an overdose.
For other people, with multiple,
chronic and serious health problems
the discussions may be less ‘if’
than ‘when’. We would have these
conversations in elderly care
settings. We would have them in
cancer care and other serious illness
contexts. We are starting to have the
conversations with older dependent
drinkers. But few agencies are
having the conversations with older
and at-risk drug users.
It’s probably worth restating the
dual nature of these conversations,
and introducing a note of caution.
They could on the one hand be a
‘The enormity of
sitting down with
a piece of paper
saying “Dear Mum
and Dad, if you
get this then…”
was for this young
person, a catalyst
for change.’
catalyst for change. But they can
also form part of a package of
care for a planned and dignified
death, where the person’s end-
of-life wishes are known and can
be respected. Workers engaging
with such discussions should be
clear in their own heads why they
are having the discussion and the
purpose of it.
In the relentlessly optimistic
world of hope and recovery from
addiction, such conversations
may seem – literally – morbid.
But they are long overdue and our
reluctance to have them deprives
drug users who die the dignity and
rights we afford to other members
of society.
Kevin Flemen runs the drugs
education and training initiative KFx
– www.kfx.org.uk
Workshops have moved online
during the current lockdown.
Email [email protected] for joining
instructions.
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