Living with death conversations

People with fatal conditions who aren’t dying soon are a new breed. These people face a different dilemma to those with short life expectancies who can benefit from end of life conversations. The certainty of a delayed death combined with regular testing by health professionals who want to keep tabs on disease progression is unprecedented. The ability to generate a nearly continuous stream of medical data through regular blood and tissue sampling has never been so cheap or easy. Health professionals have never been so well informed. Pathology labs have never been so busy. But never before have patients been such unwitting recipients of so much up-to-date information about their life and looming death. Feeling scared by this deluge of worrisome medical information is natural, especially for patients with serious, life-ending diseases like cancers and degenerative diseases. How should patients and carers respond to the onslaught? Two proposals. For patients: we know that end of life conversations hold a host of benefits. So start a ‘living with death conversation’ with your health carers. Tell them how you feel and ask what they can offer. For health carers: consider the potential impacts of regular testing on patients living with life-limiting conditions and offer or refer them to support, counsel and evidence based advice.

1. Wright AA et al (2008). Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA, 300(14), pp 1665–1673
2. Jenkinson, S (2014) Die Wise: A Manifesto for Sanity and Soul. North Atlantic Books, Berkeley, California, p35