Column

What’s so special about dying?

We are all dying. It is time to correct the half-logic that says we must give one quality of treatment to those who have been given a specific time limit, and a different quality of treatment to the rest.

Death is no longer a commonplace event for people in the west. Usually it is not until a person is middle-aged that he or she encounters the death of a close relative or friend.

It is probably this remoteness, coupled with the fact that death is uniquely mysterious, that explains our culture’s reverence for the dying person. And this is where the half-logic begins.

Think about Joe Smith. Joe had been delivering milk in the neighbourhood for as long as anyone can remember. But then one Tuesday Joe doesn’t come. Word gets round that Joe’s in hospital — it’s cancer.

Six months later he’s back. It is a brief return, but during it Joe is treated very differently. His customers still listen to the gossip, but with only half an ear. Most are deafened by strange feelings of respect for Joe who is somehow very different now.

So how has Joe changed? His body is not longer physiologically normal, although is could be argued that cancer is hardly an unnatural state. His life expectancy has been shortened, but none of us know for certain how long we will live. He is more frightened that he was, but many people with various jobs and experiences are helping him to adjust to his future. Joe has not changed radically, though his circumstances have slowly evolved. What has changed is the way Joe is perceived by others.

And this is the point at which we need to extend the half-logic into full logic, to extend the principle that informs Joe’s care as a dying person into healthcare as a whole.

Now that it must be openly acknowledged that Joe’s life is finite it is much easier to see him as a complex individual with a unique life history who still has a future, albeit a shorter one than he expected. Health workers and others are now free to pay attention to the whole range of potentials that are open to Joe.

If he has physical pain it will be relieved if possible. If he has emotional pain, or spiritual pain it will probably be noticed and a remedy will be tried. If he wishes to paint or to write it is likely that time will be spent to assist him. In short, the realistic potentials that might benefit him, whatever they are, will be identified and given in the name of healthcare, so long as resources permit.

So what is so special aboyt dying? Why is it that the nature of healthcare changes for those diagnosed as terminally ill? There is no logical reason for it. If this sort of care can benefit Joe now, it could have benefited him a year before his cancer.

Inevitably expectations of the care will change. The medical treatment will be aimed at symptom relief. But these are side issues. Joe no longer has the potential to be a milkman, but this was always only one among many of the potentials that were lying latent in him. The basic healthcare task remains the same: identify the potential developments and work with the person to ensure they become a reality.