“Not much of a life”

“It's a life but it's not much of a life,” says a patient with chronic cardiac failure (p 929). “I'm ready for the knacker's yard.” Others tell of screaming for breath, frightened, waiting for the end with all treatment options exhausted. Cancer patients have a good understanding of their disease and prognosis. They are told they are ill. Patients with heart failure have scant insight into their condition or likely outcome but are reassured that they are well.

Our third theme issue on chronic disease highlights how end of life care is prioritised by diagnosis rather than need. Simon Stewart and John …