End of life brings with it a number of requests, wishes, demands and challenges for both patients and those deemed important to them. One of the challenges is how the patient's dying wish can be realised or fulfilled before they die. Without doubt, such wishes inevitably involve support from healthcare professionals, like community nurses, to achieve fruition. Therefore, this issue cannot be discussed without including nurses and others, such as family members and doctors, who may also play a crucial role in helping patients achieve their wish.
It is important to recognise patients' wishes, and community nurses can ensure there is a proper (honest) conversation that takes place to elicit this information. Honest conversation gives patients the encouragement and hope that, as professionals, community nurses will do everything in their power to support their wishes. Although the advance care planning (ACP) initiative can help patients convey their wishes, at times, that casual, non-threatening, informal conversation can elicit more specific wishes, such as having a beer before they die (James, 2019), which may not normally be listed in the ACP documentation. Identifying the preferred place of care and death is important not only for many patients but also for healthcare professionals and relatives who need to make future plans, and everyone concerned must be well informed. By extension, professionals can feel confident to discuss sensitive issues about dying openly and honestly if this is done in a less formal manner than ACP documentation.
It is also important to acknowledge that the wide range of patient wishes will reflect individual and cultural differences. The tweet by James (2019) is about the patient's last wish to have a beer before he dies. This wish may seem trivial, but as it turned out, this exchange not only had an impact on the patient, who enjoyed his beer, but also led to significant appreciation from his family, who wrote to thank the nurse for a?ording this request. Thus, it could it argued that the bereaved also have something positive, albeit minor, to focus on with their experience as they grieve. As the tweet from James (2019) clearly suggests, it was all because the nurse and her colleagues talked to the patient and listened to what mattered to him—a beer, among other things. Despite cultural claims of moral obligation to fulfil such wishes, palliative care providers should take a professional common-sense approach to care at the end of life. It is often about doing the right thing by the patient (not doing things right) and, at times relaxing or pushing the boundaries within which palliative care is provided.
Why is a dying wish important?
The purpose of dying wishes can be multifactorial, from personal to including others, mainly those deemed important to the dying person. The request for a dying wish signifies that the patient is aware of their impending death and, therefore, open and honest conversations often follow. When achieved, dying wishes serve to pacify the dying person and, therefore, have a positive impact on how people think and feel about their life, and how they die. Caring for the psychological dimension of patients is part of the holistic person-centred approach to palliative care (White, 2018; 158–169). A dying wish may serve to fulfil something that the person has always wanted but not had the opportunity or courage to do or ask for. Dying wishes may be prompted by the fact that life is full of choices, and people do not know what it would have been like had they chosen a different path. The other point to consider is that dying wishes may be a way of managing or o?setting possible regrets that people may have. For example, patients often tend to ask for things they would never expect to get if they were still healthy.
Community nurses will come across many patients requesting to have a dying wish fulfilled. The first thing would be to weigh up the feasibility and legality of meeting the request and then quickly triggering ways to make it happen for the patient. Some patients may have regrets about certain aspects of their life and will want to ensure they have addressed these before they die. People are bound by social norms and usually die in a social environment. Some patients may feel the socialisation of their life—and now their dying—has led them not to live their own life. This could be a regret they experience and may be more common among those from large families. It is from this and other background contexts that dying wishes might stem.
The main point to consider is how palliative care professionals and community nurses in particular can help patients fulfil their dying wishes. This would go a long way in helping both the dying person and the bereaved.