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Doctors, Don't Philosophise About Death - Just Listen To Your Patients

24/02/2017 16:25 GMT | Updated 24/02/2017 16:25 GMT

In a recent review of Dr Seamus O'Mahony's new book, The Way We Die Now, PD Smith, also a doctor, praised him for his searing honesty. Dr O'Mahony has apparently diagnosed all that is wrong with society's approach to death and dying. We are told death has replaced sex as the new taboo. The cause is evangelical atheism, which has left us unsure of how to behave when faced with the great events of our lives.

On closer inspection however, Dr O'Mahony's honesty itself is more revealing of the problem than the cure. It demonstrates the failure of some doctors to understand the progress society has made when it comes to thinking about death.

Coming under attack are Advance Decisions (also known as 'living wills'), a legal tool proven to improve care outcomes and patient satisfaction and reduce unwanted hospital admissions - they are dismissed as nothing more than 'a distraction'.

Lindsey Briggs, the widow of Paul Briggs, who was left minimally conscious following a motorbike accident, would disagree. She has said that because Paul did not have an Advance Decision their family were 'powerless'. As a result, Lindsey had to fight the hospital in charge of Paul's care for Paul's wishes to be respected. Lindsey won the ensuing legal case, which allowed Paul to die peacefully on 21 January.

Also in the firing line is public demand for an assisted dying law, apparently a misguided 'obsession', 'founded on a rather naive view of human nature'. Last month Noel Conway launched a judicial review of the law that prohibits assisted dying. Noel has Motor Neurone Disease and has been told he is expected to die in the next 12 months. He is not naive, he has confronted the reality of his situation and concluded that the options available to him are simply not acceptable.

What would Dr O'Mahony say to Lindsey and Noel? That their stances on these issues, informed by the cruel reality of the circumstances they have found themselves in, are not valid?

Advance Decisions and assisted dying both empower people to make decisions about how they are cared for. They are logical expansions of person-centred care. Person-centred is critical, because care should be centred around the person receiving it, not the doctor providing it.

This notion appears to be lost on Dr O'Mahony, it also seems to have been overlooked by many representatives of the end-of-life care sector, particularly in the debate around assisted dying. In 2015 the National Council for Palliative Care (NCPC) issued a joint statement with the Association for Palliative Medicine (APM) arguing that when MPs consider assisted dying, they should not view it as compatible with end-of-life care. MPs listened to them and rejected the proposals.

In an undignified attempt to add extra weight to their view the NCPC and APM proclaimed that the voices of those working within end-of-life care 'must be given particular weight'. When discussing end-of-life choices, surely weight must be given to the views and experiences of dying people? Yet for some reason, neither dying people nor the public can be trusted.

Why not?

Polling from the Dying Matters coalition shows that two thirds of the country feel comfortable talking about dying with family and friends. Collective outpourings of social media grief for celebrities have become the norm. Barely a month goes by without a beloved soap character confronting their fictionalised mortality.

Death is not a taboo, it is all around us - on our televisions and Twitter feeds. The problem is not that the public is incapable of having a conversation about death, the problem is that decision-makers - doctors and MPs - are not listening to what they are saying.

In absence of a safeguarded assisted dying law dying people are carving out freedoms for themselves, either by travelling abroad to die or ending their own lives behind closed doors. Tragically the economic, logistical and emotional barriers to such acts mean many more people still suffer against their wishes in their final days, even when in receipt of high quality palliative care. Attempts to fix this situation, such as through Noel Conway's legal case, are not misplaced attempts to 'tame' death, as Dr O'Mahony concludes. Far from it, they are reasonable responses, put forward by the only experts that matter - dying people themselves.

Dr O'Mahony, the NCPC, the APM and indeed the British Medical Association would rather look away and pretend the current law works, hoping that dying people will give up their attempts at control and hand power back to the establishment. Unfortunately for them the era of paternalism is over. Doctors' views no longer trump the lived experience of the people they care for.

The medical profession should not be able to dictate what choices dying people have available to them. This is where the application of searing honesty is needed most. Death is a taboo that doctors need to break for themselves, because society is way ahead of them.