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Discussing dying: five minutes with Paul Cosford

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k697 (Published 14 February 2018) Cite this as: BMJ 2018;360:k697
  1. Richard Hurley
  1. The BMJ
  1. rhurley{at}bmj.com

Richard Hurley heard Public Health England’s medical director, who has lung cancer, talk to the Royal Society of Medicine about options at the end of life

“Six months into my diagnosis of incurable lung cancer, I don’t have all of the answers. These are only my views; we all have our own.

“As a society we need to be much more open in discussing how we can help each other to die well, whatever we mean by that: every individual has different needs and considers different things important.

“But we’ll do better if we don’t wait until a few days from the end of our lives before we think about it. The prevalent belief seems to be that all pain and death is avoidable, even though we know that this isn’t true. So, when pain comes, and death is imminent, we haven’t thought about it and don’t know how to handle it.

“Thinking that I might have some control at the end of my life allows me to focus on living well now. And I probably will, because of my knowledge of the system, but it isn’t the same for everyone. To enable choice at the end of life—taking account of individual care needs—may need a change in approach, and this might include options for the use of assisted dying.

“But I have concerns about this too, because it might further the delusion that we can all have a perfect death, creating unrealistic expectations of doctors and healthcare. Also, if we go down this route without dealing with the underlying societal issues around dying, we risk missing the point of putting individual patients at the centre of everything we do: carefully, thoughtfully navigating their way together through to the end of life, with appropriate care and support.

“Whether or not we should change the law on assisted dying should not be our sole or even main focus. Just seeing it as an issue of which side we’re on misses the point. We should focus on how to help all of us approach the end of life in the way that works best for us all individually.

“When the time comes, the last gift I want to give my family is for them to be able to say that I lived well and died well.”

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