I read with interest Seamus O’Mahony’s piece (“We doctors can’t prescribe a ‘good death’”, Comment, last week). He is correct, of course, regarding there being report after report on this vital societal issue that affects us all.
However, the real concern is that they are each describing the same problems while cataloguing little progress across the key issues that we know must be addressed if we are to improve the quality of care for the dying.
These include robust education and training for all clinicians who come in to contact with patients who are dying, increased research funding and, perhaps most important of all, good communication.
The Lancet Oncology once described the demise of the Liverpool Care Pathway (LCP) as the “triumph of politics over evidence” and Baroness Neuberger herself acknowledged in her report that the LCP supported good care when properly implemented.
Her recommendation to withdraw the LCP was one of more than 40 recommendations, which were to be welcomed for their potential, if properly implemented, to drive up quality of care.
To continue to construct a discourse of “abject failure” of the LCP misses the point and, worse, acts as the centrepiece for the excuses, in report after report, as to why we aren’t getting to grips with what we know to be the real issues in care for the dying.
We know how to care for dying people well. It requires commitment, funding, clinical care combined with compassion and, above all, honest, consistent leadership if we are to succeed.
Professor John Ellershaw
Director, Marie Curie Palliative Care Institute
Liverpool
I disagree with Seamus O’Mahony when he says that we have a “contemporary culture obsessed with youth and beauty, dismissive of the old”.
That’s certainly not true so far as governments are concerned when, on the one hand, pensioners are given assured, above-inflation rises (the so called triple lock) along with free bus travel and winter fuel allowances regardless of their wealth, while benefits for youngsters are frozen, those under 25 are exempt from the national living wage and there is talk of increasing university tuition fees still further.
And people such as Judi Dench and the ubiquitous Helen Mirren give the lie to those who say once you’re past 70 that’s it!
Tim Mickleburgh
Grimsby
Seamus O’Mahony mentions “obsession with personal autonomy”. I would have thought recognising and protecting a basic human right was a good thing. I don’t want to give control of my life – or death – to someone else. We’re supposed to work in partnership with people. That doesn’t mean they can have exactly what they want, but surely the best thing is a negotiated outcome.
I’ve seen quite a bit of death. They have mostly been peaceful. Some people managed to go home to die, although this doesn’t suit everyone because of the level of care required. District nursing services have been slashed. Getting services organised is often difficult. Carers may be elderly and unable to cope. People are scared, they’re not properly supported. And on top of that, death just doesn’t happen like you see it on the TV. There is rarely that last conversation, swiftly followed by closing eyes and gentle exhale.
We shouldn’t be scared of death because it’s part of life. We should explore options for choices.
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