End-of-life care needs to be better understood and managed

http://www.theguardian.com/theobserver/2015/aug/23/the-big-issue-end-of-life-care-assisted-dying

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Your editorial is absolutely correct that still more must be done to make sure that a dying person’s final days are made as peaceful as possible (“Too many are still denied a dignified death”, Comment). This requires transforming the approach that is taken to end-of-life care, with strong national and local leadership to make this a priority so that care is available for everyone, wherever they choose, whatever their diagnosis and whenever they need it.

Dying, death and bereavement also have a wider impact beyond health and care, which is why we believe that the government should set up an independent review that looks at the ways in which public bodies could better meet the needs of people when it comes to the end of life and making your wishes known, including through lasting power of attorney and wills.Claire HenryChief executive, National Council for Palliative CareLondon N7

In his recent Reith lectures and his very readable book Being Mortal, Dr Atul Gawande brings together discussion on dignity in dying and care for the elderly. Doctors have more interventions at their fingertips than may be necessary and shouldn’t perhaps always bring on the treatments just because they can. Dr Gawande favours consulting elderly patients on their quality of life, asking five questions about their wishes and expectations, and finds that not everyone wants to die hooked up to tubes and machinery in a hospital in which staff, with all the will in the world, cannot give every patient all the attention he or she needs. Many choose to stay at home, with appropriate medical visits or attention.

Dr Gawande works in the US, where there is an option for hospice care visits at home, but it should be possible, and cheaper, to set up similar schemes within the NHS, which would also ease “bed-blocking”. Nicci Gerrard’s initiative will help enormously if hospital is the only option, but patients approaching the end of life should at least consider letting nature take its course and may indeed, with appropriate care, live much longer than expected, relaxed in their familiar surroundings with time to take stock and surrounded by family and friends. Diana BarnesSouthampton

Recent FOI requests by Channel 5 revealed nearly half of clinical commissioning groups have frozen or cut their end-of-life care budgets, 70% of trusts do not run mandatory training in care of the dying and just 7% hospitals offer the necessary 24/7 palliative expertise. Worse still, as your quoted palliative expert Professor Robert George reported to my mother’s coroner, if this expertise is purely advisory and not “empowered to act” it is “not fit for purpose” for more complex cases. This means that, in contrast to hospices where this is available, few if any hospitals offer the level of care necessary to competently manage all their dying patients. This is scandalous and unsafe. Hundreds of thousands are at risk of a painful or otherwise undignified death each year in our hospitals. This must be urgently acknowledged and addressed now. Richard von AbendorffLondon SE23

Your editorial asks: “What makes a good death?” and replies: “For a few, it is the right to control the timing of the last day of their lives.” The facts are quite contrary to what you state: a very large entrenched majority (80% or more) in this country have made it clear in repeated polls that they would prefer physician-assisted suicide, were it legal. And as you should also know, anyone wishing to go to Dignitas faces very considerable financial, legal and other obstacles. Colin HowsonEmeritus professorLondon School of Economics and Political ScienceLondon WC2