Forgotten wisdom: what happens when we die?

Dr Kathryn Mannix is a Palliative Care consultant based at the Royal Victoria Hospital in Newcastle, who began the UK’s first dedicated palliative care CBT clinic.

‘We’re all going to die!’

No, not a scary action movie, but life. We have been dying for millennia and notwithstanding medical advances, the death rate remains 100%. And yet, despite so many opportunities to study the phenomena around dying, most doctors are unable to describe the process that takes people out of the world.

What a contrast with the processes of pregnancy and birth, to which magazines, shops and websites are dedicated; lessons are delivered in schools; couples are invited for ‘birth practice’ sessions as the due date approaches… Perhaps not all of these analogies are directly transferable to the process of dying, especially as 50% of candidates will expire suddenly, but dying is a recognisable process and modern medicine has largely forgotten it in the rush to postpone it.

Societal changes to the way we perceive death

Anthea Gellie and her co-authors form an eclectic team of researchers from diverse backgrounds including Medicine, Psychology, Science, and Humanities. Their paper Death: A Foe to be conquered? Questioning the paradigm reflects on changing attitudes to death and the need for a change to the current paradigm. Anthea tweets at @AntheaGellie

Whittington on his death bed – Thomas Brewer. Courtesy of the Mercers’ Company. Photograph by Louis Sinclair.

There are few certainties in life—death is one of them. It is worth reminding ourselves of this age old maxim in a time when medical knowledge and technology have extended the possibilities of medical care; and when most people survive to advanced age and die in hospital, not at home. Our views on death have become skewed.

We sit at an unparalleled juncture in history, in which most of us can expect to live to old age. Compare this to medieval Britain, where life expectancy was just 30 years. It is not uncommon now, however, to survive to middle age before personally experiencing the death of a loved one. Advances in modern medicine allow us to live well with chronic illness, but we also run the risk that the lives of frail older people are prolonged to the point where life becomes a burden. Dying people often fear ‘lingering on’ unnecessarily, and have priorities such as retaining a sense of control and not being a burden on their loved ones. Yet in the medical setting, we can often overlook the wishes of a patient to have a peaceful death.

Death rates in care homes – a measure of quality?

Dr Eileen Burns is the recently elected BGS President Elect and is a Consultant Geriatrician at St James’s Hospital, Leeds.

 “My Mum no longer recognises me or my sisters. She needs help with everything- washing and dressing, eating and drinking. She is incontinent. If she could see herself like this she would be distraught. We were very relieved when her GP met with us to discuss what we felt she would have wanted for herself in this situation. We don’t feel that there is anything to be gained for her by another hospital admission- unless she has a problem which is causing her distress which they can’t alleviate here in the home. We’d like her to die here with the dignity she has left in the place and with the carers she’s familiar with”

The recent spotlight on increasing death rates in care homes accompanied by commentaries implying that this is an unwanted and regrettable development put a naive and simplistic gloss on a complex issue.

Dying isn’t Working

Following Kate Granger’s blog entry on her personal response to the withdrawal of the Liverpool Care Pathway, we present a blog from Jason Suckley, director of Policy and Campaigns at Sue Ryder, explains what healthcare professionals could do to improve end of life care

In a civilised society and 65 years since the establishment of the NHS, it’s totally unacceptable that individuals and their families remain unsupported at the one of the most life-changing and emotionally challenging times.  Your diagnosis, where you live, or who your doctor is shouldn’t pre-determine whether or not you have a good death – we want to change that.

To work towards addressing the problem, in June, we launched our campaign, “Dying isn’t Working”.  The campaign is based on our own experience as a service provider of end of life care and evidence from two reports we’ve produced with think-tank Demos – Ways and Means (published on 19 June), looking at barriers to accessing end of life care, and A time and a place (published on 9 July), exploring what people want at end of life.  Insights from the reports highlight a number of ways in which healthcare professionals can improve end of life care for all.

What is the future of care for the dying?

Kate Granger is an Elderly Medicine Registrar at Pinderfields Hospital in Yorkshire. She tweets at @GrangerKate and blogs at drkategranger.wordpress.com 

 

As a vocal advocate of the Liverpool Care Pathway I have experienced a wide range of emotions since the publication of the Independent Review regarding its use, ‘More Care, Less Pathway’.

Initially I was shocked something which had become a routine part of my post registration working life was going to be scrapped. I cannot recall such a prominent change in practice since I qualified. Personally I always found the LCP a very useful framework to employ when caring for dying patients.  As the shock subsided I will admit to some negative emotions; I was upset and angry but mostly disappointed; disappointed that our efforts to dispel the media misrepresentation and scaremongering had been in vain. A feeling of indifference followed. This is a rare feeling for me to experience when it comes to anything Palliative Care related; I am usually so passionate.

Living alone and ‘bouncing back’ after bereavement

Dr Juliet Stone, Research Fellow at the ESRC Centre for Population Change, writes on the OUP Blog about her research investigating trends in household composition and exploring how experiences and exposures across the life course can influence outcomes in later life.

Her paper ‘The transition to living alone and psychological distress in later life’ was published in Age and Ageing earlier this year.

Is living alone in later life bad for your health? As we get older, the likelihood that we will be living on our own increases. We live in an ageing population and data

from the Office for National Statistics show that in 2010, nearly half of people aged 75 and over were living on their own. So the experiences and concerns of older people living alone are increasingly relevant to policy-makers and to society at large. Physical health is a major concern as we age and living arrangements can be important, particularly if an older person has nobody living with them who can provide practical support. But what about mental health? We hear reports in the media about a rapid rise in the number of people living alone in the UK potentially leading to a “loneliness epidemic”. But the reality is likely to be more complex. In particular, older people will very often be living alone because they have outlived their spouse or partner, and bereavement will likely have its own effects on mental health. So what role does the transition to living alone play in this process?

Read the full article on the OUP blog here.