- Email: [email protected]
The joy of death
THE LANCET
The joy of death
Robert Twycross In 1997, palliative care in the U K was punctuated by three events: the 30th anniversary of St Christopher's Hospice, the 10th anniversary of specialty status for palliative medicine, and the holding in London of the 5th biennial congress of the European Association for Palliative Care. The founding of St Christopher's by Dr (now Dame) Cicely Saunders in 1967 ushered in the m o d e r n palliative-care movement and led both directly and indirectly to the other two landmarks. The EAPC congress, attended by over 2000 health-care professionals, mostly from Europe but also from places as far-flung as the Argentine and the Antipodes, reflected the extent of the spread of what is largely a British medical export. In the UK, numbers of specialist registrars are increasing and there are now seven academic departments of palliative medicine, most set up in the past 2-3 years. There is a surfeit of broad-based specialty journals, and many others focused more narrowly on, for example, pain or bereavement. The concept of specialist palliative-care units still elicits a mixture of responses. For most people, however, actually visiting one leads to the strange discovery of life and joy in the midst of death and distress. It is perhaps in The house of hospice this paradox that the secret of palliative care resides. The Palliative care acknowledges and responds to two levels paradox is the end result of ordinary, down-to-earth of experience--the surface and the deep, the conscious activities such as skilled nursing care, good symptom and the unconscious, the tangible and the intangible management, and sensitive psychological support--that is, (Mortally Wounded, Dublin, Marine: 1996). Activities that human compassion in action. All are expressions of respect facilitate the crossing from the surface to the deep levels of for the patient and of corporate activity in which experience are an important part of palliative-care professional individualism is balanced by programmes--creative activity (poetry, art, crafts, & c), muhiprofessional teamwork. The house-of-hospice model music, massage, reminiscence, and relaxation. The focus is is a good way of expressing this (figure), with its on the search for meaning and making sense of the foundation stones of acceptance (whatever happens, we will suffering. Acceptance by the establishment leads to routine and not abandon you) and affirmation (you may be dying but you are important to us). Hope, openness, and honesty are bureaucracy, which can stifle charisma and innovation. the cement. The challenge for modern palliative care as it enters its Indeed the biggest challenge facing doctors in relation fourth decade is to develop this creative tension. to palliative care is the question of truthfulness with Otherwise the palliative-care movement will decline into a patients. It is often said that telling patients that they are m o n u m e n t resting on faded laurels. terminally ill destroys hope and leads to irreversible despair and depression. In reality the opposite is more Key references for 1 9 9 7 often the case--lying and evasion isolate patients behind de H e n n e z e l M. I n t i m a t e death. Boston: Little B r o w n , 1997. either a wall of words or a wall of silence that prevents them from sharing their fears and anxieties. It is not possible to offer hopeful palliative care without a prior commitment t o o p e n n e s s and honesty (de Hennezel). Lancet 1997;
350
(suppl III): 20
Sir Michael Sobell House, Churchill Hospital, Oxford OX3 7LJ, UK
(R Twycross MD)
SIII20 "
H e a r n J~ H i g g i n s o n IJ. O u t c o m e m e a s u r e s in palliative care for advanced c a n c e r patients: a review.JPubl Hlth Med 1997; 19:
193-99. H u s e b o S. C o m m u n i c a t i o n , autonomy~ a n d h o p e . H o w c a n w e treat seriously ill patients with respect? Ann NYAcad Sei 1997; 809: 440-59. L i n d o p E, B e a c h R, R e a d S. A c o m p o s i t e m o d e l o f p a n i a t i v e care in t h e UK. IntJPalliative Nursing 1997; 3: 287-92. M c C a b e MJ. E t h i c a l i s s u e s in p a i n m a n a g e m e n t . Hospice Journal 1997; 12: 25-32.
End Of Year Review ° 1997
The joy of death
Robert Twycross In 1997, palliative care in the U K was punctuated by three events: the 30th anniversary of St Christopher's Hospice, the 10th anniversary of specialty status for palliative medicine, and the holding in London of the 5th biennial congress of the European Association for Palliative Care. The founding of St Christopher's by Dr (now Dame) Cicely Saunders in 1967 ushered in the m o d e r n palliative-care movement and led both directly and indirectly to the other two landmarks. The EAPC congress, attended by over 2000 health-care professionals, mostly from Europe but also from places as far-flung as the Argentine and the Antipodes, reflected the extent of the spread of what is largely a British medical export. In the UK, numbers of specialist registrars are increasing and there are now seven academic departments of palliative medicine, most set up in the past 2-3 years. There is a surfeit of broad-based specialty journals, and many others focused more narrowly on, for example, pain or bereavement. The concept of specialist palliative-care units still elicits a mixture of responses. For most people, however, actually visiting one leads to the strange discovery of life and joy in the midst of death and distress. It is perhaps in The house of hospice this paradox that the secret of palliative care resides. The Palliative care acknowledges and responds to two levels paradox is the end result of ordinary, down-to-earth of experience--the surface and the deep, the conscious activities such as skilled nursing care, good symptom and the unconscious, the tangible and the intangible management, and sensitive psychological support--that is, (Mortally Wounded, Dublin, Marine: 1996). Activities that human compassion in action. All are expressions of respect facilitate the crossing from the surface to the deep levels of for the patient and of corporate activity in which experience are an important part of palliative-care professional individualism is balanced by programmes--creative activity (poetry, art, crafts, & c), muhiprofessional teamwork. The house-of-hospice model music, massage, reminiscence, and relaxation. The focus is is a good way of expressing this (figure), with its on the search for meaning and making sense of the foundation stones of acceptance (whatever happens, we will suffering. Acceptance by the establishment leads to routine and not abandon you) and affirmation (you may be dying but you are important to us). Hope, openness, and honesty are bureaucracy, which can stifle charisma and innovation. the cement. The challenge for modern palliative care as it enters its Indeed the biggest challenge facing doctors in relation fourth decade is to develop this creative tension. to palliative care is the question of truthfulness with Otherwise the palliative-care movement will decline into a patients. It is often said that telling patients that they are m o n u m e n t resting on faded laurels. terminally ill destroys hope and leads to irreversible despair and depression. In reality the opposite is more Key references for 1 9 9 7 often the case--lying and evasion isolate patients behind de H e n n e z e l M. I n t i m a t e death. Boston: Little B r o w n , 1997. either a wall of words or a wall of silence that prevents them from sharing their fears and anxieties. It is not possible to offer hopeful palliative care without a prior commitment t o o p e n n e s s and honesty (de Hennezel). Lancet 1997;
350
(suppl III): 20
Sir Michael Sobell House, Churchill Hospital, Oxford OX3 7LJ, UK
(R Twycross MD)
SIII20 "
H e a r n J~ H i g g i n s o n IJ. O u t c o m e m e a s u r e s in palliative care for advanced c a n c e r patients: a review.JPubl Hlth Med 1997; 19:
193-99. H u s e b o S. C o m m u n i c a t i o n , autonomy~ a n d h o p e . H o w c a n w e treat seriously ill patients with respect? Ann NYAcad Sei 1997; 809: 440-59. L i n d o p E, B e a c h R, R e a d S. A c o m p o s i t e m o d e l o f p a n i a t i v e care in t h e UK. IntJPalliative Nursing 1997; 3: 287-92. M c C a b e MJ. E t h i c a l i s s u e s in p a i n m a n a g e m e n t . Hospice Journal 1997; 12: 25-32.
End Of Year Review ° 1997