Four future scenarios of death and dying

The future is unpredictable. The unexpected happens often and can have a major impact. Nevertheless, some thought of how the future might look is important in preparing for it. Scenarios are one way of doing this and were developed after the wholly unforeseen oil shock of 1974. Scenarios are not predictions of the future but rather sketches of plausible futures with the limits of plausibility set wide. They are not what people would like to happen but rather what might happen. They have been used to think about the future of South Africa after Apartheid, the NHS, and scientific publishing. They are in many ways devices for thinking about the present, recognising things that will be important whatever the future brings.

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Biogerontology: delaying death, promoting healthy ageing, or both?

Seamus O’Mahony

Biogerontology is the study of the biological mechanisms which control ageing, with the ultimate aim of developing interventions to delay death. In some animals, selective breeding and caloric restriction can lead to significant increases in longevity. There is no evidence, however, that such interventions work in humans. A variety of drugs and nutritional supplements (“nutraceuticals”) have been postulated as effective anti-ageing treatments, but – as some biogerontologists concede – trials looking at interventions to delay ageing would be extremely difficult to conduct, as the only meaningful end-point would be age at death, likely to be several decades after commencing the intervention. Nevertheless, there is a growing belief within biogerontology that effective strategies to delay ageing will inevitably emerge. If ageing can be delayed in other mammals, they argue, then it is only a matter of time that it can be delayed in humans, too. The biogerontologist Richard A Miller wrote in 2002: “Thus one can, with some confidence, expect that an effective antiageing intervention might increase the mean and maximal human life span by about 40 percent”. (1)

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The public health of death, dying, and grief has been neglected, but now is the time

Richard Smith

The dying spend less than 5% of their time with doctors and nurses, and 95% doing something else, perhaps alone, with family and friends, walking the dog, making love, reading poetry, or watching the television. “Dying is not hard,” said Alan Kellehear, 50th Anniversary Professor, End of Life Care, University of Bradford in London this week; it’s what happens on the journey to death, which may last years, that can be hard: anxiety, depression, fear, loneliness, social isolation, stigma, looking into the abyss, and suicide. Yet palliative care concerns itself primarily with the 5% not the 95%.

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Warme Zorg

Laura Green

Whilst reading through a student’s dissertation recently I was reminded of the little-used notion of the term ‘warm care’. In the Netherlands the term warme zorg refers to an approach to care based on Bowlby’s attachment theory and the creation of feelings of security and safety. It attends to creating a sense of homeliness (even if someone is not at home), incorporating proximity (including touch), family and freedom. Emerging from home today into the chilly, dank darkness of the Luddenden Valley, I wrapped my coat tightly around myself and on my journey I considered the meaning of warmth.

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A review of “Death” by Todd May and “The Book of Dead Philosophers” by Simon Critchley

Richard Smith

The fact that we die, argues the American philosopher Todd May, is the most important fact about us. Death is tragic, arbitrary, and meaningless, but at the same time opens us to a fullness of life that would not exist without it. That it can negate every other element of our lives, including love and wisdom, is what makes it the most important fact about us. So how should we live in the face of complete negation? How should we think about death? And should doctors, who are sometimes accused of being charlatan salesmen of immortality, pay more attention to the philosophy of death?

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Why do doctors abandon the dying? A surgeon’s answer

Richard Smith

In his best-selling book “How We Die” the surgeon Sherwin B Nuland reflects at the end of the book on why it is that doctors abandon the dying. I remember attending a lecture in Edinburgh in 1974 by Cicely Saunders, the founder of hospices, who said (and I paraphrase): “I’ve had this brilliant idea. Instead of abandoning the dying and shoving them in a corner we should pay attention to their needs, their pain, breathlessness, incontinence, thirst, angst, and spiritual hunger.” The doctors in the Royal College of physicians leapt to their feet and applauded such an innovative idea. A humble (make that naive) medical student I thought: “How did it ever happen that we didn’t do what she recommends. Isn’t that what doctoring is about?”

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Sallekhana: how Jains may voluntarily fast to death

Sallekhana (IAST: sallekhanā), also known as samlehna, santhara, samadhi-marana or sanyasana-marana,[1] is a supplementary vow to the ethical code of conduct of Jainism. It is the religious practice of voluntarily fasting to death by gradually reducing the intake of food and liquids. It is viewed in Jainism as the thinning of human passions and the body,[3] and another means of destroying rebirth-influencing karma by withdrawing all physical and mental activities.It is not considered as a suicide by Jain scholars because it is not an act of passion, nor does it deploy poisons or weapons. After the sallekhana vow, the ritual preparation and practice can extend into years.[1]

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Learning from Canada about assisted dying


Richard Smith

Discussions on assisted dying are usually heated and about whether it should be legalised. But I recently found myself in the privileged position of discussing with a well-informed group of people from Canada not whether assisted suicide should be introduced in Britain but what Britain might learn from the Canadian experience of introducing a form of assisted dying. There are many issues to decide. The meeting took place as part of the UK-Canada Colloquium, and the group included a lawyer who took a case to introduce assisted dying to the Supreme Court in Canada, a palliative care physician who provides assisted dying, and other doctors and academics who have first-hand experience  of the system.

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From medicalisation to humanisation of birth and death

Professor Lesley Page & Professor Celia Kitzinger

Birth, like death, has been over-medicalised.  Birth, like death, has moved from home to hospital – out of ordinary family life and social experience.  Many adults have never witnessed either birth or death.  Both the transition into life and the transition out of it can evoke fear in cultures in which they are unfamiliar, decontextualized, shorn of their historical and spiritual reference points.

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