Lancet Commission on the Value of Death
Listening to Ros talk about the Commission and its work, it was obviously a labour of love for her. Ros is a palliative family physician, Strategic Medical Lead at Harlington Hospice and Michael Sobell Hospice, London, UK, and Palliative Lead at Hillingdon Health and Care Partners, a partnership to provide joined-up care for people in west London. Ros is passionate about an holistic approach to end-of-life care and being more thoughtful in our medical interventions at end-of-life. She is proud of the Commission’s work in looking to reframe the way we look at death, dying and grief. Over four years, the Commissioners listened to the voices of people all over the globe as it sought to explore the role we all play, as healthcare professionals, politicians, caregivers or community advocates in shaping the meaning of death and dying. It outlined a set of principles and recommendations for action so that we can collaborate with healthcare systems to improve what people experience at end of life and in bereavement.
The Commission report is a must-read It is detailed, comprehensive, thoughtful and provocative with clear key messages and recommendations for action and the implications of inaction. The report contains fascinating demographic and economic data, and has an extensive scope ranging from the philosophy of death to concepts such as the ‘death system’.
We can all relate to its key messages including:
- Dying in the 21st century is a paradox of the overtreated and undertreated. Millions of people are over-treated in hospitals in an attempt to briefly halt death, while still more are undertreated, dying of preventable conditions and without access to basic pain relief.
- In today’s world, death, dying and grieving have become unbalanced. Formal health systems are the context in which many people die. The experience of death is often orchestrated by professionals and guided by protocols which can marginalize families and communities and undermine their unique and important support roles.
- Climate change, the COVID-19 pandemic, and our wish to defeat death all have their origins in the delusion that we are in control of, not part of, nature.
- Rebalancing death and dying will depend on changes across death systems—the many inter-related social, cultural, economic, religious, and political factors that determine how death, dying, and bereavement are understood, experienced, and managed.
- Those who suffer most from the imbalance in care for those dying and grieving are the disadvantaged and powerless. They will continue to be most affected by this imbalance unless change happens.
The report outlines a new vision of death and dying which it calls a “realistic utopia”, an exciting, hopeful and provocative concept which they say can be achieved by understanding and tackling the social determinants of death, dying and grieving; understanding and valuing that dying is a relational and spiritual process rather than simply a physiological event; networks of care leading the support for people dying, giving care, and grieving; conversations and stories about everyday death, dying and grief becoming common; and death is recognized as having value. Sounds easy!
When asked if she has hope that we can do this, Ros was resoundingly optimistic while acknowledging the huge amount of work that needs to be done. Going back to the Wheatley quote, we need to discover what we truly care about and do it!
Ros said she looks forward to attending the upcoming McGill International Congress on Palliative Care October 18-21 this year. She appreciates its holistic approach to palliative care and she looks forward to continuing the work of the Commission in bringing these challenges to open discussion. These challenges, indeed, go beyond discussion. They are a clear call to action and a responsibility for all of us. We both look forward to seeing you there and creating sustainable actions to change the future.