Life should end as well as it starts, conference hears

BMJ 2013; 346 doi: (Published 22 February 2013) Cite this as: BMJ 2013;346:f1242
  1. Bryan Christie
  1. 1Edinburgh

Families and services should give as much priority to preparing for a death as they do to preparing for a new baby, a conference in Edinburgh has been told.

Community based classes similar to antenatal sessions offered to new mothers could be one initiative to help remove the stigma concerning the end of life and encourage its discussion, the conference heard.

Surveys have shown that around two thirds of people are uncomfortable talking about death. Richard Smith, former editor of the BMJ, said that society was “in denial” about death, which resulted in needless pain and suffering for many people. The reluctance to talk about death meant that people nearing the end of life faced fear and isolation, unnecessary distress, and dying without a will and without having the opportunity of saying a proper goodbye to loved ones.

The conference, organised by the University of Edinburgh and the Royal College of General Practitioners in Scotland, focused specifically on multimorbidity in the last year of life. It considered how families, clinicians, and carers could best meet the challenge of improving their support and care of dying people.

Scotland’s chief Medical Officer, Harry Burns, said that increasing evidence showed that resilience among individuals and communities in the face of changing circumstances was an important determinant of health. He said that this was more important than smoking or poor diet in explaining premature death rates in the west of Scotland, which are among the highest in the developed world.

Too often, systems do things to people, not with them, he said, and the key lay in unlocking people’s own assets to cope better with what life throws at them. “That is what we have to do in end of life care. We have to help people to manage a whole set of new and unanticipated challenges.”

Scott Murray, professor of primary palliative care at the University of Edinburgh, agreed that such an approach was needed. He said that care at the end of life should be made as good as antenatal care, but at the moment less that 40% of patients even in the richest countries benefited from it.

He called for the provision of early, integrated palliative care that had the same type of planning that went into preparing for a new birth. Support should be given to communities and individuals to make the most of their resources, and he called for a much wider public debate and discussion of issues concerning death and dying.

Alex Jadad, professor of e-health innovation at the University of Toronto, said that health should no longer be seen simply as the absence of disease. It should be seen as the capacity of an individual or a community to adapt and manage in the face of physical, mental, or social challenges. Some people were able to manage, he said: studies have shown that a third of people with three or more chronic diseases considered their health to be good or excellent.

Discussions will take place in Scotland between the health department and the conference organisers to take forward some of the ideas explored on the day.


Cite this as: BMJ 2013;346:f1242