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Commentary: a "good death" is possible in
the NHS
Rabbi Julia Neuberger, chief executive
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Despite the fact that hospices are fashionable, we still discuss
caring for a dying person relatively little in this country. Yet any
district nurse will tell you that much of that care takes place quite
adequately in the community, although it needs a level of coordination and
sharing of knowledge and experience that is not always easy to achieve.
In recent years both my parents and my father-in-law have died in their
own homes. Our experience was of district nurses of incredible kindness
and professionalism working with the general practitioners and palliative
care service, as well as community health services providing home loans
and pharmacists ready to dispense at the drop of a hat. But this does not
always happen. All too often healthcare professionals still regard death
as a failure or simply fail to recognise that a patient is actually dying.
As a congregational rabbi I often saw unnecessary suffering and terrible
distress for family members and friends who loved the person concerned.
For people dying of something other than cancer, care was often patchy,
poor, and ill coordinated.
Ellershaw and Ward make an eloquent plea for the best care to be available
for everyonenot only for cancer patients and not only for patients who are
under the care of a specialist palliative care team. That must be right.
My father, after a long history of coronary disease, had precisely the
heart failure that this paper discusses. He was lucky; the care was
superb, both in hospital and at home. We were supported throughout, as the
health professionals carried out a mixture of tasks, irrespective of their
personal roles, so that my father could be as comfortable and as happy as
possible.
Nothing can prepare a young doctor, nurse, or rabbi for facing people
whose death is imminent, and their families, and realising that it is in
their power to make a huge difference. Nor can professional education
convey adequately just how important it is for individuals, both at the
time and afterwards, to go through the death of someone they love feeling
that they are experiencing a "good death." My personal experience of the
past few years has taught me that those last few days colour one's
memories permanently. The pain of loss is still immense, but to feel that
everything that could have been done was done, that those who cared did so
with knowledge, professionalism, devotion, and even love, and that the
person died without pain, comfortably, with those they loved around them,
is to feel immense gratitude and a curious humility. I now know that
superb care is possible within our often stretched NHS. What I do not
understand is why it is not available for everybody alike, at home or in a
hospice, nursing home, or hospital. Nor do I understand why we do not
celebrate the fact that we can, at best, provide a "good death"
wonderfully well in this country, perhaps better than anywhere else.
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