The more we have become proficient at extending life, the less we venerate death. We can hardly bear to bring ourselves to say the word, preferring to frame our language of death with awkward euphemisms and the clichés of a greetings card. How we speak reflects what we do. Death is now a muffled admission of failure, an afterthought in a world that celebrates little other than exuberant life. It is a world away from the end that our ancestors would have actively sought: the good death.
It is hardly surprising that our discomfort with death has affected the way we look after the dying person. Whilst we have a proud tradition of palliative care in this country, most notably the modern hospice movement founded by Dame Cicely Saunders, we all know that good care for the dying is far from universal. There are too many who have witnessed for themselves the tragedy of a dying relative or friend neglected simply because it was considered that there was nothing more to do to sustain their life. Each of these experiences points to the same conclusion: that we do not sufficiently value the care of those for whom there is no cure. As healthcare has become more successful, our health systems have become focused more on the curative sciences than the caring arts. The result is that when science has reached its limit, our care of dying people is, variable, haphazard and, at times - as recent reports have shown - shockingly poor.
This is an inversion of how things, properly ordered, should be. If our National Health Service and our care system is to be what we all wish it, we must all put the care of the person at the centre of all that it does. The time, effort and attention that we devote to a dying patient should not depend on whether we have the ability to extend their life. Care should be the foundation on which cure is provided. For those for whom no cure is available, we should recover our determination to ensure that the dying person has a good death.
Providing the opportunity of a good death lies at the heart of our commitment for end of life care. It is born of the Government's response to the Review of End of Life Care. The Review was a culmination of many years of research by our partners into the components of providing exceptional palliative care to the dying person.
Our commitment is that every person nearing the end of their life should receive attentive, high quality, compassionate care, so that their pain is eased, their spirits lifted and their wishes for their closing weeks, days and hours are respected. We shall ensure that all the needs of the dying person - spiritual, physical and familial - are provided for in a way that is as that person and those closest to them wish them to be. The six commitments we have published today aim to end variation in end of life care across the health system by 2020. They include:
• honest discussions between care professionals and dying people;
• dying people making informed choices about their care;
• personalised care plans for all;
• the discussion of personalised care plans with care professionals;
• the involvement of family and carers in dying people's care;
• a key contact so dying people know who to contact at any time of day.
By making this commitment, we will address poor care where it exists and accelerate improvement across the health and social care system in England. Already there are exemplary models of good care operating across the NHS and social care system: we will ensure that where care is not so good we can learn from what is best and translate it to where it is needed most. A universal provision of good care will make possible what we should expect from our health and care system - a universal expectation of a good death.
Cicely Saunders was articulating an ancient truth when she described her mission: that 'we should see the last stages of life not as a defeat but as life's fulfilment'. A good death - peaceful, dignified, reflective, compassionate, in the loving embrace of those closest to the dying person - is already a happy end for hundreds of thousands of people across our nation. In making this commitment, we make that promise universal, so that every dying person in England can live in anticipation of a good death.
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