As a health care worker and a nurse the probability that someone will die in your care is highly likely at some stage in your career. This is not something that we wish to happen of course but we know it is possible especially when the people that we care for might be very ill or very old. Helping people prepare for a good death however is not something we often discuss or research (except for the fantastic work carried out by Kubler Ross in the 1960s) and is something missing in today’s health and social care manifesto. The government of course want people to remain in their own homes for as long as possible because it is cheaper and many people when asked prefer to die at home. We are trying to make this last wish happen for people so that they can at least feel in control over what happens to them in death as well as in life.
It is when people want to end their own lives prematurely that we struggle both morally and spiritually. For whatever reason some people decide that they have had enough, they cannot see anything changing and they want to get off this planet, we refuse to help them plan their own endings.
In the story of life Buddhists teach that we should all prepare for a death in which there is least suffering. This means talking about it and even planning it. Two people have died this week many miles apart but very close in spirit. Tony Nicklinson and Tony Scott both decided to take matters into their own hands when they could no longer see a way out of their predicament. This is the power of death – to end all suffering – for ever. But it does make me wonder every time I hear about these sad endings , had they been allowed or even encouraged to talk about planning their own death – things might have been different and the stigma of dying in less dignified ways can be addressed.
There is an urgent need for compassion around this taboo subject which for many of us, is still difficult to grasp.
Julian Dodd
August 23, 2012
Breaking the Taboo and gathering the courage to talk to our patients is as rewarding as it is difficult.below is a link to a fantastic thought short talk given by Dr. Peter Saul. in his talk, he calls on us to make clear our patients preferences for end of life care — and suggests two questions for starting the conversation.
http://www.ted.com/talks/lang/en/peter_saul_let_s_talk_about_dying.html
anyachaika
August 23, 2012
One of the risks is that if we advocate for helping people to commit suicide, there is a risk that some vulnerable people may be coerced to into doing this.
Julian Dodd
August 27, 2012
Anyachaika, I understand your reservations and I agree with your concerns about suicide and coercion, however, I have always believed that if we can implement the highest standards of palliative and end of life care, there would be no need for assisted or other kinds of suicide at end of life.
Good palliative care aims to neither shorten nor prolong life, with appropriate discussion and preparation, symptoms can be anticipated and treated. With the medication and delivery systems we have at our disposal, no one should die in pain or without dignity, if we as healthcare professionals cannot provide a natural, pain-free, peaceful and dignified death for our terminal patients then we should be ashamed.
politicalnurse
August 24, 2012
thanks for that Julian (I love TED) and yes it does open up the conversation that this is not about assisted suicide but about people thinking that they are not in control of their lives when they are at their most vulnerable. It will only change when people can talk openly about death as a natural event not something that we all live in fear of.
Julian Dodd
August 27, 2012
No thank you,
On the another point raised by your piece, that of those people who decide that they have had enough, who cannot see anything changing and want to get off this planet. You speak of engaging with them as a way of helping them plan their own endings. If we are talking about people who are not terminally ill then I believe that the engagement and support should be perhaps available earlier and in more depth. We all know that wanting to die is a symptom of a well known but stigmatised medical condition (depression) and we know that depression generally responds to medication, therapy or more commonly a combination of both. What we don’t know,as a society, is how to ask for help if we feel depressed or how to recognise or advise a friend or family member who is starting on that slippery slope. The work being done to de-stigmatise mental illness is a start but I think a more focussed education like the Vinny Jones ” Staying alive” campaign would help, and would probably help more people to “Stay alive ” than CPR does
politicalnurse
September 16, 2012
What a good idea Julian CPR for mental health! Mental Health First Aid is a recognised training package run by the charity MIND but I think we need a shorter sharper message just like you suggest.