The Problem

The Problem

Sam Guglani

Despite the reality of it, humankind struggles with death—the fact of it and its implications for our lives. Even if we look back to Neanderthal societies, their burial rituals—graves readied with weapons and tools—point clearly to some hope or belief in continued life, past the sharp finitude of the material world and the keen closure of death; Karen Armstrong describes their rites as a ‘sort of counter-narrative that enabled them to come to terms with [death]’ (Armstrong, 2005). And religion, as well as galvanising people on to lead better lives, very often presents us with renditions of some sort of afterlife, either eternal and elsewhere or else repeated and so perpetuated here on earth (Holloway, 2017). All this implies a deep and persisting apprehension around death which, if not uniquely human, is exaggerated in our species, infusing as it does our behaviour, culture, art and, perhaps increasingly, our medicine.

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The changing nature of death and dying

The changing nature of death and dying

Lofland, Lyn H.. The Craft of Dying (The MIT Press) (p. 5). The MIT Press. Kindle Edition.

  Before 1950 1950 2019
Level of medical technology Low Increasing High and increasing
Detection of terminal disease Poor Improving High
Definition of death Simple Still simple Complex
Deaths from acute disease (mostly rapid) High Still high Low
Deaths from injuries (mostly rapid) High Still high Lower
Deaths from chronic disease Low Increasing The majority
Length of dying Short Still mostly short Long
Passivity in response to a person dying Common Decreasing Gone in Western medicine
Involvement of doctors in dying Low Increasing High
Familiarity with death among the population High Still high Low
Activities to “tame” death Low Low High
Community involvement in death and dying High Falling Low
Meaning in death and dying Mostly supplied through faith and faith organisations Faith and faith organisations still have an important role Inadequately supplied by multiple organisations, including the health system

The Compression of Morbidity: a real phenomenon or just wishful thinking?

The Compression of Morbidity: a real phenomenon or just wishful thinking?

Seamus O’Mahoney

Economists use the term ‘one-hoss shay’ depreciation to describe assets – such as a lightbulb – that retain value until they suddenly fail. The phrase ‘one-hoss shay’ comes from Oliver Wendell Holmes’s poem The Deacon’s Masterpiece, or the Wonderful One-Hoss Shay: a Logical Story. A ‘one-hoss shay’ , or one-horse chaise, is a small carriage suitable for a single horse. In the poem, the deacon builds his shay with such balance that all the working parts are equally strong – and equally weak. Exactly 100 years after its construction, the one-hoss shay suddenly collapses:

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Further ideas on the problem the Lancet Commission on the Value of Death is responding to

John Dewey, the philosopher, said that a problem well defined is a problem half solved. To that end the Lancet Commission on the Value of Death is working had on defining the problem, and here are some useful thoughts from Penny Dash, a friend and McKinsey partner as well as medical doctor.

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