We need to talk about the 'D' word...
Yup. The ‘D’ word. The one word that as a nation we are not good at discussing.
‘There are only two certainties in life: death, and taxes’ spaketh Benjamin Franklin.
And whilst everyone will talk forever about taxes, money and a multitude of other topics, death remains, for many, a taboo subject.
I remember during my training that no-one wanted to broach the death section on the admission forms with patients. It was seen as morbid - bringing a negative connotation to the patient’s admission to hospital and we did not want to upset the patient. However, it is often the health professional that feels uncomfortable broaching the subject, projecting their own discomfort with the conversation onto the patient.
In my first job I witnessed a doctor who just could not bring himself to tell a patient’s relatives that he was in the final stages of life. He could not say the word ‘dying’. It was stunning to watch. The patient was in end-stage cancer. He had developed a secondary infection. He was dying. And he did, two days later. But the doctor could not bring himself to say it.
So why? What is the problem? Why are we reluctant to talk about a part of life which is both inevitable and universal?
Patients may need someone else to bring up the subject due to their own worries or because they themselves are struggling with the concept of their own mortality.
I would hold that it is important to ascertain a patient’s thoughts and wishes re. death and dying so that if - perhaps unexpectedly - the worst happens, then their wishes would be known. This has become even more pertinent - most recently with regard to organ donation. It has been highlighted that, as a country, we have some of the worst statistics for organ donation. Relatives often decline - despite the wishes of patients. Potential donors are not being ‘spotted’ in areas other than ITU as it simply isn’t discussed.
Perhaps, for all - the living, the dying and the patients living with organ failure - we as a nation need to face our collective fears and reservations about talking about death and dying.
And just maybe, along with final wishes being met and a better understanding within families achieved, we may save a few more lives.
Vera Tunstall is a community nurse.
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