Lizzy Buchan: Talking about death only way to remove its sting

A perfect death probably does not exist. Picture: Greg Macvean

A perfect death probably does not exist. Picture: Greg Macvean

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What is a good death? The phrase appears to be an oxymoron, for surely death is frightening, painful and final, and devastating for those left behind?

But as everyone lives a vastly different life, perhaps death feels different to everyone too.

At a talk last week, a Glasgow GP described the privilege of witnessing the ideal death of a patient who spent their last hours in bed at home, surrounded by friends and family.

Music was played, memories were shared and tears mingled with laughter during a long and cathartic goodbye.

Such a death is not an option for everyone but questions should be asked over whether it is something you would want for yourself or a loved one if possible.

Society as a whole is ageing and people are living longer with complex conditions, so death and dying need to be up for discussion.

The medical advances that are saving lives are also prolonging them when quality of life is lower - like two sides of the same coin.

People must be given the agency to choose the death they want wherever possible, to preserve their dignity in the setting that they prefer.

This choice should also be offered across the board, regardless of diagnosis, postcode or financial status.

Sadly, two studies revealed that consistent standards of palliative care do not yet exist across Scotland.

A recent study by the University of Edinburgh measured how many patients had a vital electronic record called a Key Information Summary (KIS), where GPs can record people’s preferences and share them with hospital staff or ambulance workers.

Patients with this record were more likely to die outside of hospital, which is generally regarded as a sign of good end-of-life care.

Only 60 per cent of these patients, who were all in their final months, were getting some form of care planning before death and those dying of frailty or organ failure were less likely to be given care planning than those dying of cancer.

Another piece of research, published by the University of Glasgow, found terminally ill patients in rural areas face longer hospital stays due to shortages of end-of-life care nearby.

The findings should spark serious concern, as being in hospital is more expensive for the NHS and detrimental to quality of life.

The SNP recently made big promises about widening access to palliative care and close scrutiny will be needed to ensure these translate into action.

The rest of us can help by taking courage and starting to talk about death.

Tell your children what you want for yourself, discuss it with your GP, ask your mother what she wants at the end of life.

Almost every news story about bad end-of-life care tends to stem, at least in part, from mixed messages between doctors and relatives, or patients and relatives.

Doctors and nurses are hugely stretched, but there is no excuse for failing to explain things to families. CPR is highly stressful on the body, and it might not be an act of kindness to resuscitate an elderly woman with late stage cancer, but medics should not assume it is obvious.

A perfect death probably does not exist, in the same way that expectant mothers striving for a perfect birth may find things do not go to plan.

But that should not put us off from striving for better for everyone.

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