Is palliative care having an existential crisis?


There are just 106 days to the 17th World Congress Online of the European Association for Palliative Care (EAPC). With live sessions on 6 to 8 October, and lots of on-demand content before and after the congress.

Ahead of the congress, we’re delighted to give some highlights of what to expect at #EAPC2021. Today, Dr Seamus O’Mahony, gives a glimpse of the plenary lecture he will give.

Dr Seamus O’Mahony.

I was invited to give this lecture by a circuitous route. Two years ago, I wrote a (mildly) critical review for the Lancet of the palliative care physician Kathryn Mannix’s best-selling book With the End in Mind. I argued that the reality of palliative medicine was not as rosy as Mannix portrays, that it might suffer from “chronic niceness”, a form of emotional dissonance first described by the hospital chaplain Peter Speck. My friend Richard Smith, (former editor of the BMJ, chairman of the Lancet commission on “The Value of Death”), emailed me about this review; I suggested to him that palliative care might be undergoing “an existential crisis”. Richard then wrote a blog for the BMJ posing this question and invited commentary from Ros Taylor and Libby Sallnow (both palliative care doctors), and Lucy Selman, a researcher in end-of-life care. Although my only contribution was a long quote from my Lancet review, I was included as a co-author. In an amusingly post-modern twist, one of my co-authors described my comments as “puzzling” and “patronising”.

The blog attracted some attention – not all of it complimentary. Richard was invited by the EAPC to give a plenary lecture with this title at their annual congress in Helsinki in October 2020. He had decided a couple of years before to give up flying, so declined the invitation, but suggested that I might give it. I accepted – this was all pre-Covid. The meeting was cancelled, and rescheduled for 2021 as a virtual event, so Richard could have given it after all.

I should mention something of my background. I worked for many years in both the UK and Ireland as a gastroenterologist and general physician, retiring just before Covid in 2020. I now work for the Irish vaccine program. My book The Way We Die Now (2016) was written from the perspective of a doctor working in an acute general hospital (where most deaths in the UK and Ireland take place) and questioned palliative care’s “ownership” of death. But I’m well-disposed to palliative medicine: I’m giving this talk as a friend.

Important questions for the future of palliative care…

The word “crisis” is perhaps too emotive, but palliative medicine is at a crossroads. My talk will address what I think are the important questions for its future. Given that it cannot possibly take on all death and dying, how can palliative care positively influence the rest of medicine? Why does research on end-of-life care attract so little funding, and why are there so few academic palliative care doctors?  Hospices (particularly in the UK) are struggling financially: what should be their role? Should hospices be places providing “de-luxe dying” for the few, or should they be a resource for the many? Is palliative care contributing to the “professionalisation” of dying and, if so, how can we empower individuals, families, and communities? Should palliative care concentrate on symptom relief only, or should its mission also be spiritual and communitarian?

I can’t pretend that I have the answers to all these questions, but I’ll do my best.

Editor’s note: This post is among the Top Twenty most-viewed posts for 2021.

Join Seamus O’Mahony for his plenary presentation, which will be one of the interactive online sessions at the EAPC 17th World Congress from 6 to 8 October 2021.

Dr O’Mahony’s lecture, Is palliative care having an existential crisis?, will also be recorded and released for on-demand viewing by registered delegates until January 2022. Read the abstract of his lecture, and all other congress presentations and posters, in the Book of Abstracts for the 17th EAPC World Congress, to be published by ‘Palliative Medicine’ in the autumn.

  • Register for the EAPC 17th World Congress Online here. (Special discount for EAPC members).
  • Read the special series about the EAPC 17TH World Congress on the EAPC blog.
  • Read more about Seamus O’Mahony, his publications and other resources here.
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