“The living close their eyes to the dead. The dead open their eyes to the living” (Hindu proverb).
We share from REHUNO Health the second note of the series on the report of the Lancet Commission entitled: “The Value of Death: Bringing death to life”. The Lancet Journal, a publication of recognised scientific prestige, published in February 2022 the report of one of its Study and Research Commissions. This 48-page report is the result of the work of a team of specialists who studied society’s current approach to death and the direct and indirect consequences that derive from it. The full report of the Commission can be found at: (The Lancet Commissions: Report of the Lancet Commission on the Value of Death: bringing death back into life. www.thelancet.com – Vol. 399 February 26, 2022).
We are grateful for the contributions shared by Dr. Enric Benito in his interviews with REHUNO Salud and with the organisation Al final de la Vida, as they have been very useful for this series of articles.
We recommend reading the first article in this series: Rediscovering the process of dying (note 1).
In this second and final article in the series, we continue to summarise the relevant aspects of the report:
- Conversations about death and dying are often difficult. Doctors, patients or relatives may find it easier to avoid them and continue with treatment, even if it is inappropriate to the end-of-life process.
- Palliative care can provide better outcomes for patients and caregivers and lead to a better quality of life in the final stages and often at a lower cost. But, for the moment, attempts by palliative care to influence conventional health care services have had very limited success.
- As was the case during the COVID19 pandemic, it is the most disadvantaged who suffer most from the imbalance in care during the end-of-life process and when bereaved.
- Re-balancing death and dying will depend on bringing about changes in the various social, cultural, economic, religious and political factors that determine how the dying and bereavement process is understood, experienced and managed. A reductionist and linear approach that fails to recognise the complexity of the dying system will not achieve the necessary rebalancing.
Radically re-imagining a better system for accompanying the dying process, this Commission has set out five principles of a realistic utopia. These principles are:
- Social determinants must be addressed and taken into account in every dying situation, in the dying process and in bereavement;
- Dying is understood to be part of a highly significant human, relational and spiritual process, rather than simply a physiological event;
- Social care networks should lead and support people in end-of-life and/or bereavement processes;
- Conversations and stories about everyday death, dying and bereavement become part of a profound communication between people, their families and the accompanying teams, not hidden or silenced.
- The dying process is recognised as having a “value” in itself that is very important for the person and his or her family and social environment.
Systems are constantly changing and there are many programmes in place that encourage a rebalancing of our relationship to death, dying and bereavement. Communities in diverse geographies are challenging norms and rules about the care of dying people, and models of citizen and community action such as compassionate communities are emerging as highly relevant.
Changes in policy and legislation are recognising the importance of these issues and supporting the availability of pain management drugs in dying. Hospitals are changing their culture to recognise and address dying processes more broadly. Health care systems are beginning to work in partnership with patients, families and organisations on these issues and to integrate holistic care of the dying into all health services.
These innovations do not yet amount to complete system change, but they reflect a preoccupation and social responsibility backed by a broad social movement comprising tens of thousands of volunteers and organisations pushing for these paradigms.”
Concluding the report, the Lancet Commission states:
“…To achieve our ambition to rebalance death, dying and bereavement, radical changes in all systems are needed. It is a responsibility for all of us, including global agencies and governments, to take up this challenge. The Commission will continue its work in this area”.
