Managing chronic diseases: End of life is more than death

doi:10.1136/bmj.330.7497.963-a

BMJ 2005;330:963 (23 April), doi:10.1136/bmj.330.7497.963-a

Letter

Managing chronic diseases

End of life is more than death

The first 150 words of the full text of this article appear below.

EDITOR—In advanced, non-malignant, chronic illness, theproximity of death and the inadequacy of treatment to preventit change the patient's circumstances. Accurate prognosis maybe impossible and that also influences the circumstances. Althoughdoctor and patient may know death is approaching, planning isneeded for a stage of life that could continue for a year ormore. For example, two year survival in patients with advancedchronic obstructive pulmonary disease is 50-64%.^1
2 Murray etal warn against a paralysis of clinical decision making, butthe inaccuracy of prognosis in these diseases presents complexchallenges.³

Planning for death in advanced chronic disease may seem pessimisticwhen life still holds rich possibilities. Murray et al seemto use the term end of life as a euphemism for death.³ But thecontext of their editorial demands a broader understanding.Approaching the end of life has implications distinct from imminentdeath. These . . . [Full text of this article]

Patrick White, senior lecturer

Department of General Practice and Primary Care, Guy's, King's and St Thomas' School of Medicine, King's College London, London SE11 6SP patrick.white@kcl.ac.uk