Dr Joseph M Sawyer, Core medical trainee at St George’s Hospital, London, UK, explains the background to his longer article published in the July/August of the European Journal of Palliative Care.
The relationship between community, ill health, life and death is clearly complex but packed deep within it is the essence of what drives us to do well for one another. Surely then, as practitioners, charged with providing direction to our health service, we should have some insight into this fascinating and fundamentally important relationship?
To understand what death means to us we need to have some appreciation of our individual existence in the context of what it means to exist as a whole. A useful analogy would be that of a wave. The wave exists as a separate entity and is a wave in its own right, yet at the same time it is born out of the depths of the ocean and from its conception to its end at the shore edge it never loses its connection with the ocean at large. It is a continual relapsing and remitting cycle of energy. This is a natural process that suggests a feeling of equilibrium and balance. A feeling that is at odds with the fear, pain and suffering that surrounds modern societies’ image of death.
How then do the structures we have created in health care fit into this exclusively natural paradigm? For some time, it has been recognized that health services do not deal well with death. 1,2 The extent of our anxiety towards death is noticeable in our attempts to control the events that lead up to it. From contraception through pregnancy and beyond we have developed interventions that empower us with a sense of control that can easily be mistaken for care. We understand very little about death, we have no control, we feel uncomfortable and suddenly all the emotions of fear and failure seem all too familiar.
This leads me to question does our health service care? Or does it merely seek to control as a proxy for something that is far more emotionally and intellectually challenging?
If we are to have a health system that cares, a system that reduces suffering and promotes equality, then we must seek to bring the concept of death back to life. Realising this has led me to write the article ‘Cure or care – diagnosing death in the modern era’ that is published in this month’s edition of the European Journal of Palliative Care.
My work has taught me that placing real value on concepts of interdependence, community, and compassion can provide us with an approach that appreciates the complexity of ill health in relation to death whilst providing a real force for change. We all want to care for our patients and feel suffocated and trapped when we are unable to do so, perhaps we can change our approach and help end the suffering for ourselves as well as our patients?
- Paton A. Letting go (personal view). BMJ. 2009; 339 (b4982).
- NCEPOD. Deaths in Acute Hospitals: Caring to the End?: National Confidential Enquiry into Patient Outcomes and Deaths; 2009. 115 p.
This post relates to a longer article, ‘Cure or care: diagnosing death in the modern era’ by Joseph M Sawyer, published in the July/August 2016 edition of the European Journal of Palliative Care (EJPC). (vol. 23.4).
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