Kathryn Mannix's paper ("What Happens When We Die?", published today) goes to the heart of the end-of-life debate. Advances in medical science and health care have increased longevity but they have also had the effect of medicalising serious illness and dying. As Dr Mannix puts it, any condition that threatens mortality can be met with a rush to hospital to prevent death. "Death is seen, by the public and by some healthcare staff", she writes, "as a failure of medical treatment instead of the inevitable consequence of having been alive".
As a result, though most people say they would wish to die at home, dying often takes place in hospital and we have as a society become less familiar with witnessing dying and understanding its characteristics. "Three generations of Britons", writes Dr Mannix, "have been prevented from observing the onset and progress of dying at first hand". What is unfamiliar all too easily becomes frightening. As Dr Mannix puts it, "Now that so few people have witnessed dying, they have neither familiarity with the process nor any measure of whether it is proceeding comfortably and predictably. Deaths on film and television become the public's references. Normal dying is rarely portrayed, so the inexperienced viewer assumes that dying in torment is usual. The majority of the bereaved, who have witnessed gentle, normal dying, are not moved to tell the world of their reassuring experience, and so the balance is never redressed. Even when death would be welcomed, fear of dying badly whilst enduring physical and emotional distress may haunt the ill and the aged".
Such misperceptions of death and dying lie at the heart of the end-of-life debate. "We cannot prevent sadness at the death of a loved one", writes Dr Mannix, "but we can challenge the conspiracy of silence that leaves many of us to live misinformed and unnecessarily fearful". Britain has recently been ranked in first place among 80 nations for the quality of its end-of-life care. What is needed is that this excellence of care is cascaded from hospices and specialist palliative care teams into community medicine and nursing, that it is accessible seven days a week and that a joined-up approach is adopted to medical and social care. That is what Baroness Finlay's Access to Palliative Care Bill is all about: we should give it our support.