The Lancet Commission on the Value of Death: understanding a realistic utopia.

Death, dying, and loss are universal human experiences, but the contention of a new Lancet Commission is that they have become unfamiliar, disconnected, and unbalanced. For the next in our Palliative Care and Public Health blog series, Dr. Libby Sallnow tells us why. 

Photo of Libby Sallnow

The Lancet Commission on the Value of Death: bringing death back into life builds on the earlier Lancet Commission on Access to Pain Relief and Palliative Care (2017) which demonstrated the serious inequity surrounding the way people are dying around the world and the stark global divide in access to basic pain relief or palliative care services.

This new Commission, however, moves beyond the challenges of palliative care services, symptom control or certain life-limiting conditions to take a whole-systems view of death, dying and loss. How these universal events are experienced by individuals and their families are shaped by the same factors that shape the whole of people’s lives. The social, structural, and political determinants of health are also the social, structural, and political determinants of death, dying and loss.

It is this interconnected nature of living, caring, dying, and grieving that forms the basis of the Commission report and frames the intentions for the future. Death, dying, and loss are complex social processes that change in response to societal shifts. If we are to seriously change experiences at these times for all, changes must take place across entire systems rather than only within individual parts. Palliative care services and indeed healthcare systems must be seen as one component in a larger, interconnected whole.

Though systems are constantly in flux, they are designed to maintain the status quo. Changes in one part may lead to unanticipated shifts in a different part and it is possible to intervene to radically change systems. The realistic utopia of the Commission is a set of five principles to guide and inform radical but achievable, system-wide changes for death, dying, caring, and grieving:

  1. The social determinants of death, dying and grieving are tackled, to enable people to lead healthier lives and die more equitable deaths
  2. Dying must be understood to be a relational and spiritual process rather than simply a physiological event
  3. Networks of care must lead support for people dying, caring, and grieving
  4. Conversations and stories about everyday death, dying, and grief must become common
  5. Death must be recognised as having value.

Examples of intentional and unintentional system-wide changes in death, dying and grieving can be seen throughout the world. The hospice and palliative care movement in the last century and the death awareness and Compassionate Communities movements in this century have shifted attitudes, practices and experiences for many around the world. Broader influences include conflict, changes in legislation relating to opioid prescribing or assisted dying, efforts to achieve immortality or greatly extend human lifespans and societal narratives on what constitutes a ‘good’ death. The climate crisis shows us how planetary health and human health, and future deaths, are interconnected. Parallels can be drawn between the delusion that we are in control of, rather than being a part of nature, leading to climate change, and the belief that we can overcome death and achieve immortality, rather than death being seen as an integral and natural part of our lives.

As palliative care practitioners and leaders, we have a responsibility to see our work in this broader context, and to help others within these systems to recognise their role in influencing how people care, die, and grieve. We must make these connections, work with new partners, reach across boundaries, understand and share the interconnected and social nature of death, dying, caring and grieving. It is through this approach that we will leave the most significant and enduring changes for those dying and those important to them.

The Lancet Commission on the Value of Death is a global commission with Commissioners from twelve countries from a range of disciplines, including but beyond palliative care and health care. It commissioned a series of working papers, original research and reviewed and synthesised a wide range of material from case studies and reflections to national datasets and empirical work.

Links and resources

  • Read the Lancet Commission on the Value of Death: bringing death back into life here.
  • Find out more about this work and read the commissioned papers on the Value of Death Commission website.
  • ‘The Future of Dying – Creating a Network for Change: Understanding and exploring ‘The Realistic Utopia’ from the Lancet Commission on the Value of Death’, St Christopher’s Hospice. A virtual event on 21st June 2022. Find out more and book tickets here.
  • The Lancet Commission on Access to Pain Relief and Palliative Care.
  • Find out more about the EAPC Reference Group on Public Health and Palliative Care.
  • Read more about Public Health and Palliative Care on the EAPC blog.
  • The End-Of-Life Care research group is hosting the 7th international Public Health Palliative Care International conference ‘Democratizing caring, dying and grieving: participation, action, understanding and evaluation’. Bruges, Belgium, 20 – 23 September 2022. Find out more here.
  • The End-Of-Life Care research group Public Health & Palliative Care Research Summer School is taking place on 14 to 17 September 2022, in Ghent, Belgium.

About the author

Libby Sallnow is a palliative medicine physician and academic working at St Christopher’s Hospice, UK, Vrije Universiteit Brussel, Belgium, University College London, UK and the WHO Collaborating Centre in Community Participation in Palliative Care, Kerala, India. She was the lead author for the ‘Lancet Commission on the Value of Death: bringing death back into life’. Twitter: @libby_sallnow. ORCID ID: 0000-0001-7079-9637.

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