Einstein said that if he had an hour to solve a problem he would spend 55 minutes defining it and five minutes thinking of solutions.
We would like to agree on the problem we are considering and will welcome comments. We will keep developing the text of the problem until we are satisfied.
So please comment and ask others who you think might be interested to contribute.
Society and medicine have an unhealthy relationship with death, which means:
There is gross global inequality in how people die: many people in the world die without any access to care or morphine
Overtreatment is common in high income countries at the end of life
Overtreatment is spreading to people in low and middle income countries, often pushing families into poverty
Doctors find it hard to talk to patients about death and dying and opt instead for continuing treatment
Spiritual needs are neglected; indeed, perhaps medicine is incapable of responding to those needs
Many people die badly (we know what people die of and at what age, but we know little about the quality of dying; place of death is a poor measure of quality of death)
Overtreatment at the end of life is a major driver of heath costs and of expenditure being concentrated in hospitals, where most deaths take place; this high expenditure crowds out other programmes around education, housing, city design, environment, and the like, which do more for health than does health care
Resources are shifted to the old rather than the young, creating intergenerational unfairness and possibly conflict
Medicine has come to see death as “failure” rather than “normal”
Resources in medicine and medical research are concentrated on countering mortality rather than morbidity
Medical research implicitly (curing cancer, heart disease, dementia, neurological disorders, etc) is implicitly if not explicitly pursuing immortality
Death increasingly occurs in old age and from prolonged frailty, giving people a long time to experience “biographical pain” and generating large costs
The “compression of morbidity” is pursued but seems to be a myth
Palliative care is beneficial, but is not available to most people in the world–and its existence as a medical specialty can mean that doctors in other specialties shy away from death
The curative medical model is pre-eminent as a driver of health service priorities; supportive and palliative care services remain marginal, often relegated to charitable NGOs
Plans for developing health systems often give little or no attention to end of life care
One of the main jobs of culture/religion is to provide meaning to life and death and rituals to govern death and dying, but medicine replacing religion as the “owner” of death and dying has led to loss of meaning and rituals around death and dying. People are left with an existential crisis that medicine can’t help (Ivan Illich)
“In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality, and created a new difficulty for mankind: how to die.” (Atul Gawande)