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GPs go forth

Death taboo makes it difficult for patients to hold their dignity at the end of life

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Death and taxes. Even former boyband members cannot avoid the former. Yet, as a society, we seem increasingly reluctant to accept this as an unshakable fact of life.

The death of a girl ‘too young’ for cervical cancer screening and the elderly woman who fell and broke her hip – someone has to be blamed for the failure to prevent the inevitable.

And care planning has become embroiled in this mess. What was considered pragmatic and sensitive care is now deemed discriminatory to octogenarians. Grim reaper medics who sign DNR forms without liaising with relatives are condemning them to an early grave.

How and when did we get so squeamish about death? The Victorian era swept sex under the carpet but was more than happy to normalise, ritualise and celebrate death. Queen Victoria turned grief in to a fashion statement after her husband died, as she paraded around in her newly found widow’s wardrobe. Today, sex education often starts as early as year one at school, but children are still rarely seen at funerals and wakes.

Not all cultures adopt this stiff upper lip and we could learn a lot from them. Today, I had the most wonderful conversation with an 85-year-old Pakistani woman who sent her son out of the room so she could speak to me alone. 

She informed me that she wanted to meet her maker fully clothed and did not wish to lose her dignity during death, least of all in front of men. It took me a few minutes to recover from this random but rational expression of advanced care planning, and I asked her if she was happy to talk further about these issues. Her reaction was one that needs to be framed and placed on all hospital walls: ‘Death is a certainty; running from it will not make it go away.’

She went on to explain that she pleaded with Allah to take her while in the middle of her prayers; more specifically in the head-down position, as this was the most pious way to go. She did not wish to be a burden on anyone in her family and wanted to depart in a physically and mentally fit state.

I’m pretty certain these sentiments are not unique to her. I would imagine many people over the age of 80 would share her feelings, but they would be reluctant to express them proactively. Family, society, fear and the pursuit of immortality handicap people and prevent them being true to themselves. The only way to reverse this tide is to normalise death – to allow children to be a part of this ceremony, to talk openly about what is inevitable and to stop looking for blame in every death.

Perhaps if medical soap operas such as Casualty and Holby City were prevented from glamorising CPR, so that the public saw the reality of the fractured ribs, the regurgitation of body fluids and exposure of flesh, we would have an alternative narrative on DNR. Without this shift in culture, there is very little doctors can do to ensure the inevitable is as natural and peaceful as possible.

Dr Shaba Nabi is a GP trainer in Bristol. 

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Readers' comments (7)

  • Vinci Ho

    The problem is these policy makers , bureaucrats and of course, politicians are 'feeding' on perceived fear of the public and twisted the meaning of 'prevention' so often. 'Prevention can stop things from happening completely' ideology is popular to voters......

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  • Samuel Jackson

    Nice blog, many thanks Shaba.
    I thoroughly recommend "The immortalisation commisson: The strange quest to cheat death" by John Gray who also authored "Straw Dogs"

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  • Thank you for expressing so well what as been one of modern medicine tabus.

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  • I wish to see the standard introduction of dignity passports for all that enter into hospital. That way, whether we live or die in there, our dignity in life or death is preserved as we see fit for ourselves.

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  • Anon 11.06am

    That's the best laugh I have had for a while. What on earth is pro-muslim bias when it's at home and why do you have to remain anonymous?

    I happen to work in a practice with a lot of muslim patients and I speak punjabi. It is not surprising that my anecdote would be about a patient who happens to be a pakistani muslim.

    I suspect the bias is entirely on your side, assuming I am a muslim owing to my name and skin colour.

    As it happens, I am an atheist and quite happy to state this. But your assumptions are quite staggering.

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  • A lovely poignant reflection Shaba. Keep up the good work.
    Anon 11.06, I think you owe Shaba an apology.............

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  • Wonderful blog Shaba. stunned by the response from Anon 11.06

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