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Final Days

Here’s some good news about bad news: a survey in 2015 found that the United Kingdom was number one in the world for the quality of the palliative care offered by its medical services and practitioners. Palliative care we receive in our final days, when doctors can no longer do anything to restore us to health, but can make it easier and more comfortable for us to pass away. Pain can be reduced or removed, mobility maintained and a good quality of life kept up right to the end.

This is something we’ll all face: if birth is like the firing of an arrow into the sky, then the arrow must come down sooner or later, no matter how far it flies and how high it soars. Death is the arrow’s descent. But it can land in soft earth or shatter on hard rock. Palliative care is designed to make the landing as soft as possible, not only for the person who passes away, but also for those who care about that person and are often present in the final moments. As Dame Cicely Saunders once said: “How people die remains in the memory of those who live on.”

Who is she? Someone who should be much more famous, because she has been central to the revolution in hospice culture and palliative care that has helped make the UK number one in the world in this fields. She understood something very important: that death and dying aren’t things that involve only the body. The mind and emotions are an inseparable part of the process. Death can seem terrifying and hateful, an obscene and unnatural intruder that brings misery and fear even to someone who does not suffer physically as they pass away.

That’s why it best to begin thinking about our final days long before we think our time is due. Someone in their twenties is barely a quarter of the way through their expected life-span, but that doesn’t mean they can’t take time to think about how and where they want to die. And there’s an organization here to help us: the Dying Matters Coalition, set up by the National Council for Palliative Care in response to guidelines issued by the Department of Health about care in the final days of life.

The Dying Matters Coalition (DMC) can offer advice about those all-important steps towards facing our own mortality and deciding what our preferences are for our final days. We’re familiar with the phrase a “good life”. But what about a “good death”? That was something that countless people prayed for in the past, when doctors were less skilled and had much less knowledge of pain-control and the body’s response to drugs. In those days, a severe injury or serious disease could make the final days and hours of life a truly horrible experience both for the sufferer and for their loved ones.

Today, no-one should have to suffer bad pain and distress in their final days. A good death should be something we can reasonably expect, not something that we hope we’ll be lucky enough to experience. And the “Dying Matters” central to the DMC’s mission are becoming more important with every passing year. As the UK’s population both increases and ages, so the number of people in need of palliative care will inexorably increase. More of us are dying every year, and more of us are confronting the need for a soft landing at the end of the arrow’s-flight of life.