It's time to talk about dying

Lack of openness about death has negative consequences for the quality of care provided to the dying and bereaved. Jane Seymour, Sue Ryder Care professor of palliative and end of life studies, at The University of Nottingham says to change attitudes to dying we have to eradicate ignorance about what can be achieved with modern palliative care and encourage dialogue about end of life care issues.

Professor Seymour is the lead author of one of a special series of articles which are published on bmj.com on September 17 2010, in the first BMJ "Spotlight" supplement: Palliative care beyond cancer. The articles explore how lessons learnt from end of life care for cancer patients can be adapted for those dying from chronic conditions like heart failure and dementia.

Attitudes must change if we are to achieve a good death for all, say the experts. By 2030 the annual number of deaths around the world is expected to rise from 58 million to 74 million, but too many people still die alone, in pain, without dignity, or feeling alienated. The article written by Professor Seymour and colleagues discusses the consequence of not talking about and planning for death, public attitudes to euthanasia,physician assisted suicide and how to raise awareness and public involvement.

Professor Seymour says: "While in some ways our society is obsessed with death - with reports of violent, sudden, and unexpected death paraded across our media every day - it is still very difficult to talk about this one shared certainly in terms that relate to our own deaths or those of people close to us.

"When death is managed badly it leaves a scar that runs deep in our collective psyche and reinforces the tendency to turn away from any reminder of death. Shifting attitudinal barriers to the provision of excellent end of life care means eradicating ignorance among clinicians, patients and the public about what can be achieved with modern palliative care and with careful proactive planning.

"Raising public knowledge of issues surrounding death, dying and bereavement risks raising expectations we cannot yet meet or sending an unrealistic message that death can always be managed well. But such activity is a vital part of generating a sense of wider responsibility for the dying and promoting social justice for all those living towards the end of their life."

The authors have drawn on research commissioned by the National Council for Palliative Care and the National End of Life Care Programme and a survey of UK public attitudes commissioned by the National Coalition Dying Matters: Let's Talk About It - to which all three authors belong.

"Palliative care beyond cancer" also topped a recent BMJ poll of topics respondents wanted to read more about, suggesting that doctors are keen to be more open about death and deliver better end of life care for their patients.

Source: University of Nottingham