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Health Matters - Dying Well

Health Matters - Dying Well
15 March 2017

Dr Paul Bowen, clinical chair of NHS Eastern Cheshire CCG and GP with McIlvride Medical Practice, Poynton

It is difficult to write about death without sounding morbid, ageist or inappropriate. However, like much the health service does, it is something we can get right or terribly wrong.

We all want a peaceful, dignified end to our lives but what about the weeks, months and years running up to that point? As we live longer, and get frailer in the process, this is something the NHS cannot ignore any longer.

A regular conversation I have with older patients and their families is focussed around quality of life rather than just “quantity” of life. By that, I mean a discussion about what priorities people have when they get older. It is easy to medicalise the ageing process. If doctors look for problems in an average 90 year old, they will find them. Whether they can be treated to extend life is one thing but whether it will improve quality of life is as important to many people.

Discussing and planning the final years of our life is a difficult and distressing thing to do. Two thirds of healthy adults do not even make a will.  A terminal diagnosis often prompts a candid conversation about our priorities but many people do not have the opportunity to explore and confirm their priorities in later life. This includes where we would want to be cared for, and the importance of dignity, comfort, continuity or independence over the ever-present risk of hospitalisation, investigations and treatment.

GPs working in our local care homes are being encouraged to start these conversations with their patients and their families. Increasingly we discuss the same issues with older people in their own homes.

It is entirely appropriate for the NHS to continue to treat, admit, investigate and manage patients to the end of their lives. Many older people quite rightfully wish to pursue every treatment available, and do so in comfort, with dignity and in a place they wish to be.

However, it will take a cultural change for us all to realise that “a good death” starts with an honest discussion about our priorities, whether it’s our length or quality of life, care in our home or our hospital, surrounded by loved ones or care staff. There is no right or wrong but it would be inappropriate and ageist for GPs and other NHS staff NOT to explore these issues at an appropriate time in our lives.

Visit the Cheshire Living Well Dying Well Partnership for excellent advice and resources on living well, ageing well, grieving well and dying well.