It is expected in the twenty-first century that the most basic requisites of dignity should be afforded to all in society, especially those who are least able to speak up for themselves.
The health charity Sue Ryder reported that the National Health Service (NHS) was not providing access to 24-hour care, with approximately 92 per cent of the 180 Clinical Commissioning Groups (CCGs) who responded to the survey (out of 211 CCGs) stating that they were not providing around-the-clock services (‘Dying at home patients ‘lack 24-hoour expert support’,’ www.bbc.co.uk, 16 October 2014). This situation is despite the fact that the guidelines state that telephone services should provide this service and the NHS admitted that that it is ‘working hard to make changes.’
It is important because it is the link for the half a million carers for terminal patients in England.
In a corresponding survey carried out by Populus for Sue Ryder, approximately four out of five adults support the availability of 24-hour advice for those people who are dying. A similar amount of respondents thought that 24-hour emergency home visits should be available to alleviate pain and other symptoms.
Meanwhile, the Macmillan Cancer Support has warned that older patients should not be ‘written off’ as too old for treatment (‘Older cancer patients ‘should not be written off’,’ www.bbc.co.uk, 24 January 2014). The charity cited data which suggests that 130,000 people aged 65 years and over diagnosed with cancer between 1991 and 2010 survived for more than ten years. Macmillan Cancer Support conducted the research together with the National Cancer Intelligence Network which discovered that of the 130,000 who had lived with cancer for more than a decade, 8,000 had been diagnosed over the age of 80 years.
Despite these findings, the charity added that cancer survival rates in this age group were ‘poor’ compared to other age groups.
Ciaran Devane, the Chief Executive of Macmillan Cancer Support, commented: ‘It’s wrong to write off older people as too old for treatment.’
He added: ‘with a proper assessment and appropriate treatment, our research shows that many older cancer patients can live for a long time and can even be cured.
‘While its good news that so many older people are benefiting from treatment, many thousands more could live longer if our survival rates for over-65s matched those in comparable countries.’
He continued that barriers, including ‘age discrimination and inadequate assessment methods,’ must be addressed.
Dr Mark Porter of the British Medical Association stated that it should be a ‘key part’ of the medical profession to ensure that older patients are ‘treated with the care and respect they deserve.’
It is an important point as one in three breast cancers in women over the age of 70 years, according to Public Health England (PHE) (‘Elderly breast cancer warning,’ www.bbc.co.uk, February 2014). Approximately 13,500 women aged 70 years and over are diagnosed with breast cancer in England each year, with survival rates being lower in this particular age group. It is thought that a lack of awareness of symptoms other than a lump, such as changes in breast size or shape, could be behind the poor survival rate.
Also worrying is that fewer than half of patients known by medical staff to be in their final days were told that they were dying, according to an audit by the Royal College of Physicians (‘Most terminally ill patients not told they are dying, says damning report,’ www.telegraph.co.uk, 14 may 2014). Less than one in five patients had a discussion with medical staff as to whether they should have a drip to give them fluids or nutrients.
Other findings were:
· One-fifth of patients were asked about their spiritual needs at the end of their life.
· Between 60 per cent and 80 per cent of patients had the recommended standing prescription for pain relief and other medicines to relieve symptoms at the end of their life.
· In the last 24 hours of their life, fewer than half of patients were on pain relief medicines (although experts stated that this requirement is not always necessary).
· Less than one in three patients were on a drip to give them fluids at the end of their life and only seven per cent were receiving nutrients through a tube.
· Approximately nine in ten families were told that their loved ones were dying, on average 31 hours before their death.
· More than a third of families stated that the emotional support they received from medical staff was fair or poor.
Claire Henry, the Chief Executive of the National Council for Palliative Care and Dying Matters Coalition, commented: ‘The way we care for dying people says something fundamental about our values as a society, as well as being an acid test for how well the NHS is working, which is why many of these findings are so deeply disturbing.
‘There can be no excuse for hospitals failing to treat people with dignity, compassion and respect when they are dying, at the time that they most need this.
‘It is simply unacceptable that so many dying people appear not to have been told that they are in their last days of life – something our own research shows the majority of people would want to be told about – and that important decisions about artificial nutrition and hydration are not being discussed with them or with their relatives and friends.’
Caroline Abrahams, the Charity Director at Age UK, stated: ‘Sixty per cent of people die in hospital. Yet, this study makes it clear that we are still not giving them the care they deserve.
‘Many families are not being properly consulted about the way their dying relatives are looked after and palliative care needs to be available around the clock. That requires more and better training for general hospital staff who will care for the dying when specialist services aren’t available.
‘With an ageing population where more and more of those facing death are likely to suffer from multiple conditions, this is critical if we are to give people the dignity and respect they deserve in their final days.’
Where a person is coming to the end of their life, it is considered that more terminally ill people should die naturally and with dignity in hospices or in their own home (‘Terminally ill people should be allowed to die naturally at home says former Tory leader,’ Iona Institute, 24 July 2014; ‘NHS ‘should work more closely with hospices’,’ www.bbc.co.uk, 23 July 2014). It has been calculated that half of people dying in hospital, despite 80 per cent preferring not to. The Help the Hospices movement is aiming to reduce the number of people dying in hospital by a fifth, which equates to 50,000 individuals.
Lord Michael Howard, the chair of Help the Hospices and the former leader of the Conservative party, commented: ‘Hospital has become the default option for dying people and for an increasing number of frail elderly people. Hospital should be the last resort at the end of life, not the first one.
‘This has resulted in inappropriate and often poor quality care that completely fails to support dying people’s actual needs and deprives them of alternative care options.
‘Hospices can provide the solution by leading moves to provide and facilitate alternative forms of care, whether through their own inpatient units or working closely with their local hospital to deliver alternative options.’
There are constant injunctions in the Bible to look after the weak and unable to help themselves. The reason is that we are all made in the image of God (Genesis 1: 27) and so are special to Him. Indeed, we are considered a little lower than the angels (Psalm 8: 5).
The Christian is to be clothed with kindness and compassion (Colossians 3: 12, cf. 2 Peter 1: 7), so they should encourage others to have the same attitude toward those who are ill and dying.
When we have dignity to those coming to their end of days on earth, we have God’s perspective on those He has made.
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