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 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?
A regular conversation I have with older patients and their families is focused 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. A terminal diagnosis often prompts a candid conversation about our priorities but many people do not have the opportunity to 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 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. It would be inappropriate and ageist for NHS staff NOT to explore these issues at an appropriate time in our lives.
Visit the Cheshire Living Well Dying Well Partnership at http://eolp. co.uk/CLWDW/index.php for excellent advice and resources on living well, ageing well, grieving well and dying well.