the way we die now

C53d91d194c9844afbf7d9e8d15eae83Seamus O'Mahony at The Dublin Review of Books:

Death, for most people, is a rumour; something that happens to others, far away. But it is the last thing you will 'do' – or which will happen to you – and the likelihood is that it will take place in an acute hospital or a care home, orchestrated by strangers. You will have little say in its pace or its manner. There is a risk that, during the course of your dying, you will be subjected to procedures and treatments that are painful, degrading and ultimately futile. If you are old, your children may make all the major decisions for you. Death may creep up on you without warning, without a chance for you to prepare yourself and settle your affairs.

Few books, as R. D. Laing remarked, are forgivable. Most of what I read about death and dying bears little relation to what I see every day in my work on the hospital wards. Doctors and nurses rarely write about death; those who do are generally palliative care (hospice) specialists, and have a particular perspective on the subject, one that I do not completely share. The language used about death and dying tends to have a quality of cloying earnestness: nobody 'dies' anymore; they 'pass over', they 'pass on', or they simply 'pass'. The book I wanted to read about death and dying didn't exist.

Doctors who work in large, acute-care hospitals see death differently to doctors working in the hushed and serene environs of a hospice. And yet most dying still takes place in this kind of hospital, rather than in the hospices. Half a million people die every year in England. A study of deaths in England between 2005 and 2007 found that 58 per cent of all deaths occurred in hospital, 16 per cent in nursing homes, 19 per cent at home and only 5 per cent in hospices.

more here.