Professor Scott Murray, Fellow of the RSE and Emeritus Professor of Palliative Care at Edinburgh University.
Death is the final frontier we will all one day face. COVID-19 has propelled many of us there abruptly and prematurely, but as pandemic-related deaths decline, dying will once again take longer. It’s a fact of life that we have a 100% mortality rate, and most of us will have time to anticipate and optimise how we die.
Numerous studies show that planning ahead allows individuals to die according to their wishes, and to avoid inappropriate treatments. Most people in Scotland now die with such plans in place, but many still miss the opportunity to influence many details.
If talk of dying is always considered a negative, we lose a great opportunity to get actively involved in planning what we want, and to bring our own personal beliefs and resources to the table. If we hope against hope for a cure, research shows that we may receive treatment of doubtful benefit, which may harm us and even shorten our life. We will also be less likely to receive comprehensive care that brings comfort and dignity –nowadays called palliative care- tragically missing out on the opportunity to influence and personalise our own dying.
How do we die nowadays? It is rarely realistically portrayed in the media or discussed in public. We tend to see death as a dramatic tool to initiate a plot twist in a TV show, or a tragic and sudden announcement in the paper. However, studies show that very few people die of a sudden illness such as a heart attack or stroke. With the increased range of treatments available, sudden death is dying out.
In medieval Europe there was a concept of the “Dance Macabre”, or dance of death. Paintings and books of the period described dying as a last dance, which allowed people to consider their final days and the possibility of bowing out in style. Nowadays progressive cancer is relatively quick, with a clear beginning and end, like an eightsome reel. Organ failure may cause intermittent decline, like dips in a tango when hospital admission may ensue. Dementia or frailty may give a gradual decline over many years, like a final slow waltz. Dying is different for different illnesses, so good to understand how things usually progress in the relevant illness.
Medical professionals are now trained to have “anticipatory care planning” conversations with patients to explain, discuss and document preferred treatment options, when a life-threatening diagnosis is given. Your “prognosis” is not simply how many weeks or months you have left to live (which may be very difficult to estimate), it is understanding the likely series of events, in order for you to plan ahead.
So, if the day should come when death taps you on the shoulder, boldly think and plan for the final frontier, and then get on with living life to the full in the meantime!
Scott Murray is Emeritus Professor of Palliative Care at Edinburgh University, and a Fellow of the RSE.
This article was originally published in The Scotsman on Monday 10 May, 2021.