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Matt Morgan: An ordinary death

BMJ 2022; 378 doi: (Published 20 September 2022) Cite this as: BMJ 2022;378:o2242
  1. Matt Morgan, consultant in intensive care medicine
  1. Western Australia
  1. mmorgan{at}
    Follow Matt on Twitter: @dr_mattmorgan

The palliative care physician and author Kathryn Mannix described the death of Queen Elizabeth II sadly and beautifully on Twitter last week.1 She wrote about how the Queen’s gradual adaptation to frailty in recent years, involving less travel and more rest, was an inherent part of mortality—or “ordinary dying,” as she put it. While media outlets have concentrated on the dramatic moment of the Queen’s death, Mannix pulls us away from the screens to consider the process behind the event.

In the intensive care unit we increasingly meet frail, older patients who have been referred to us for multiorgan support for “reversible” problems. These may include severe infections, support after major bowel surgery, or serious strokes. We are asked to consider the event of the patient’s illness as something that could be fixed with drugs, machines, nursing care, and, most importantly, time.

And often they are right. The problem may indeed have a fix. The event may pass. These punctuated incidents, these isolated catastrophes, may have a solution. But this is to look only at the event, not the process behind it.

This focus is partly the fault of those of us working in the deep technology of the intensive care unit (ICU). We have long concentrated on numbers, physiology, and looking for reversible problems. However, as we gain a better appreciation of survivorship, we are moving away from framing our patients’ health problems as events and towards understanding them as processes. The narrative of the patient’s journey towards the ICU is often more important than the signal event that knocked on our door.

Like Mannix’s specialty of palliative care, ICU is one of the few medical specialties that feature the word “care” in their name. But as well as caring for the patients and families, we need to care about the process leading to an event. When considering patients’ best interests, we need to ensure that fixing one event in this case can lead to good.

Even in the face of frailty, a good life is still possible as an aim. As Mannix says, “At the end of life, we can still enjoy love, and peace, and companions.”

Let’s keep that as our goal, rather than just seeking to fix single events.


  • Do read the wonderful Twitter thread that underpins this column at:

  • Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Matt Morgan is an adjunct clinical professor at Curtin University, Australia, honorary senior research fellow at Cardiff University, UK, a consultant in intensive care medicine at the Royal Perth Hospital in Australia, and an editor of BMJ OnExamination.