By the way... When it can be wrong to save elderly lives

IT WAS a shock to learn at medical school that death from natural causes is a rare, if not nonexistent, event. Nobody dies of nothing.

There is always a reason. Going to sleep at a great age and not waking up the next morning, or sitting down in an easy chair after lunch and no longer being alive when a cup of tea arrives at teatime, is the peaceful end we all long for. And yet even that so-called death from natural causes remains unexplained in terms of what caused the terminal moment.

One cause of death might be pneumonia. This used to be known as ‘the old man’s friend’, the implication being that it’s not a bad way to go. However, in this era, great efforts are often made to treat pneumonia, with antibiotics, intravenous fluids and oxygen beating an illness which would otherwise be fatal — thus the old man’s friend is thwarted.

Medical care has advanced massively during my career. A study by the British Heart Foundation has shown that the proportion of people dying from cardiovascular disease (heart attack or stroke) has fallen by 40 per cent over ten years.

But to be spared these diseases means people will live on to get a fatal cancer, or dementia. And with dementia you may ultimately die of infection due to urinary troubles, or bedsores, or maybe even cardiovascular disease. What we, as healthcare professionals, must increasingly train to do is to learn when to compassionately hold back on active treatments.

I’d like to make a heartfelt cry for the skills of hospice and palliative care experts to be extended. Often their skills are targeted at those with cancer, but they could be hugely beneficial to those with dementia and other illnesses. Not only do they have expertise in ensuring end-of-life care is comfortable, but they also ensure it is appropriate.

These professionals know and understand the value of not necessarily throwing the book at every medical complication.