Death is the common denominator of life. Mortality statistics appear
in many guises, and reflect the coldness of death within populations.
Dr Heath challenges us to reflect on the current pattern of life and
dying in this country and the wider world (2). Her discussion is informed
by a conviction that something is not right with the world: Young people
die ‘tragically’ so we should divert resources to let them live longer.
Old people encounter serial, multiple pathologies but are sustained
expensively in life to endure dementia. The value judgement is that life
in old age and most particularly in dementia has little worth. Thus
resources should be redirected on economic and moral grounds to improve
the health and survival of the young.
Perhaps we are doing some things wrong, but one thing is for sure -
present world policies are delivering just what Dr Heath wants: more
people are surviving childhood and into later life worldwide and this
process extrapolates into the future (3). Deaths amongst young adults are
increasingly associated with violence rather than illness: violence on the
roads, on the streets, in warfare and by suicide.
The prospect of being older may seem unattractive to some such as Pete
Townsend: ‘Hope I die before I get old’ (4)
Yet successive cohorts of elders are fitter and more able than their
predecessors. The wisdom of years and centuries says that life is dear for
most even when they are old:
‘When the time comes nearer, and even when the day is at hand, people
usually prefer old age to death’ (5).
Living with dementia is a life with opportunities as well as difficulties
(6).
Futile medical interventions or treatments should not be initiated
when the end of life becomes inevitable, irrespective of age. They are not
in the best interests of the patient. Non-maleficence remains part of the
ethical framework guiding our actions (7).
Working and studying in Palliative Care, we find that holistic assessment
and management of distressing symptoms, appropriate to the wishes of the
patient and their family, enable life to be lived to the fullest; not
looking at progressive frailty and illness through the flawed rose tinted
lens of denial. Generalisations overlook the individualised care our
patients seek in their closing days. A palliative care approach has much
to offer in these difficult areas, especially helping to improve
communication between patients and healthcare providers, ensuring
individualised care for individual patients.
Using palliative skills engenders hope for the future in the face of
adversity, a gentle nuance altering conventional curative medical
approaches. The process is often more subtle than the young man’s death
(8).
Dr Heath does us valuable service in asking that we consider these
matters. She should be reassured that much is going well with the health
of the world in response to present programmes. It is surely right,
however, that more be done to educate policy, professionals and the
general population in the appropriateness of respectful and dignified
support of people when they are dying whatever their age (9)
(1) ‘Old Before I Die’ Robbie Williams Life Thru a Lens 1997
Chrysalis Records
(2) Heath I. What do we want to die from? BMJ 341 181
(3) You D, Wardlaw T, Salama P and Jones G Levels and trends in under
-5 mortality 1990-2008. Lancet 375 100-103 2010
(4) ‘My Generation’ The Who My Generation 1965 IBC Studios
(5) Simone de Beauvoir ‘Old Age (Les Vieillesse)’
1977 Penguin Books Harmondsworth
(6) Bryden C. Dancing with dementia: My story of living positively
with dementia
Jessica Kingsley London 2005
(7) General Medical Council. Treatment and care towards the end of
life; good practice in decision making’. GMC 2010
(8) McGough R. Let me die a young man’s death. In The Mersey Sound:
Adrian Henri, Roger McGough and Brian Patten. Penguin Modern Poets 10
Penguin Books London 1967
(9) Jolley D and Tapley M Due respect and professional care in death.
The Psychiatrist 34: 143-145 2010
We declare no conflicts of interest.
Competing interests:
None declared
Competing interests:
No competing interests
09 August 2010
Charlotte Talbot
Medical Student Leeds Medical School
Dr Michael Tapley and Professor Dave Jolley
Elective at Willowwood Hospice, Ashton-under- Lyne. OL6 6SL
Rapid Response:
Old before I die
Old Before I Die (1)
Death is the common denominator of life. Mortality statistics appear
in many guises, and reflect the coldness of death within populations.
Dr Heath challenges us to reflect on the current pattern of life and
dying in this country and the wider world (2). Her discussion is informed
by a conviction that something is not right with the world: Young people
die ‘tragically’ so we should divert resources to let them live longer.
Old people encounter serial, multiple pathologies but are sustained
expensively in life to endure dementia. The value judgement is that life
in old age and most particularly in dementia has little worth. Thus
resources should be redirected on economic and moral grounds to improve
the health and survival of the young.
Perhaps we are doing some things wrong, but one thing is for sure -
present world policies are delivering just what Dr Heath wants: more
people are surviving childhood and into later life worldwide and this
process extrapolates into the future (3). Deaths amongst young adults are
increasingly associated with violence rather than illness: violence on the
roads, on the streets, in warfare and by suicide.
The prospect of being older may seem unattractive to some such as Pete
Townsend: ‘Hope I die before I get old’ (4)
Yet successive cohorts of elders are fitter and more able than their
predecessors. The wisdom of years and centuries says that life is dear for
most even when they are old:
‘When the time comes nearer, and even when the day is at hand, people
usually prefer old age to death’ (5).
Living with dementia is a life with opportunities as well as difficulties
(6).
Futile medical interventions or treatments should not be initiated
when the end of life becomes inevitable, irrespective of age. They are not
in the best interests of the patient. Non-maleficence remains part of the
ethical framework guiding our actions (7).
Working and studying in Palliative Care, we find that holistic assessment
and management of distressing symptoms, appropriate to the wishes of the
patient and their family, enable life to be lived to the fullest; not
looking at progressive frailty and illness through the flawed rose tinted
lens of denial. Generalisations overlook the individualised care our
patients seek in their closing days. A palliative care approach has much
to offer in these difficult areas, especially helping to improve
communication between patients and healthcare providers, ensuring
individualised care for individual patients.
Using palliative skills engenders hope for the future in the face of
adversity, a gentle nuance altering conventional curative medical
approaches. The process is often more subtle than the young man’s death
(8).
Dr Heath does us valuable service in asking that we consider these
matters. She should be reassured that much is going well with the health
of the world in response to present programmes. It is surely right,
however, that more be done to educate policy, professionals and the
general population in the appropriateness of respectful and dignified
support of people when they are dying whatever their age (9)
Miss Charlotte Talbot
Medical Student, Leeds
on Elective at Willowwood Hospice,
Ashton-under-lyne, Lancashire OL6 6SL
char1ie_talbot@hotmail.com
Dr Michael Tapley
Hospice Doctor
m.tapley@willowwood.info
Professor David Jolley
Consultant Psychiatrist
dessjol@yahoo.co.uk
References:
(1) ‘Old Before I Die’ Robbie Williams Life Thru a Lens 1997
Chrysalis Records
(2) Heath I. What do we want to die from? BMJ 341 181
(3) You D, Wardlaw T, Salama P and Jones G Levels and trends in under
-5 mortality 1990-2008. Lancet 375 100-103 2010
(4) ‘My Generation’ The Who My Generation 1965 IBC Studios
(5) Simone de Beauvoir ‘Old Age (Les Vieillesse)’
1977 Penguin Books Harmondsworth
(6) Bryden C. Dancing with dementia: My story of living positively
with dementia
Jessica Kingsley London 2005
(7) General Medical Council. Treatment and care towards the end of
life; good practice in decision making’. GMC 2010
(8) McGough R. Let me die a young man’s death. In The Mersey Sound:
Adrian Henri, Roger McGough and Brian Patten. Penguin Modern Poets 10
Penguin Books London 1967
(9) Jolley D and Tapley M Due respect and professional care in death.
The Psychiatrist 34: 143-145 2010
We declare no conflicts of interest.
Competing interests:
None declared
Competing interests: No competing interests