Portia

I meet people who are nearing the end of their life every day when working. Maybe 2 or 3 people over the years have voiced strong persisting wishes to have things “sped up” or to go to Switzerland. Some have started with this view and it faded away as their symptoms are controlled and they have time to adjust a little more to the new reality they find themselves living in. Every day I meet people who want to live as long as possible, their families want this too. People are willing to undergo difficult chemotherapy that may offer only a few more weeks or short months. They ask about trials and supplements that might help. Their loved one encourage them to eat and build themselves up, to keep fighting and to keep going. Part of my job is to help people navigate this ever changing tidal wave of information and emotions alongside other health care professionals. I also meet people who do not prioritise time but wish to maximise the quality of the time they have left. Accepting that not having a medical or surgical treatment may shorten their life, they value the shorter time at home over a longer time that involves hospitals and medicalisation. Those who want to live longer and those who want to focus on quality of life both require optimal control of symptoms. As a medic this forms the biggest part of my work alongside the conversations around realistic medicine and humanity’s response to terminal diagnoses. For the small number of people who have persisting wishes to pursue assisted dying there is massive political and media interest ongoing. Where it will end up remains to be seen. Meanwhile let’s not lose sight of the overwhelming majority of people who need good symptom control to achieve their wishes. Those who need someone to talk to about their last weeks, days and hours. Who require timely access to hands on care, nursing care, medications and medical review. Those who require spiritual support, company when isolated and bereavement support when someone dies. All of this is required thousands of times every day in the UK and the need continues to grow. Regardless of what happens with assisted dying we need good palliative care across all care settings. Without this then countless people will experience distress that could have been alleviated or prevented. We do not know the true limits of palliative care as its provision and reach has never got anywhere close to its full potential. Lack of funding, challenges with research, reliance on charity and a medical model that has kept dying at arms length have all played a role. For decades palliative care professionals and many other health care professionals have campaigned for improved end of life care. Change has been slow despite the UK being a proclaimed world leader in palliative care. Now we wait to see what becomes of the renewed political interest in end of life care expressed by so many in parliament recently. Many promises have been made and sentiments shared. I hope this is seen through and translates to the practical care of those in need, its a long way from parliament to the small home of someone dying on the margins of society or someone brought to A+E by ambulance at 2am on bank holiday as they are unable to die at home without overnight care. You won’t hear as big an uproar about these realities in care gaps despite it affecting so many every day. People’s stories turn into statistics while “how people die lives on in the memory of those left behind.” Let’s not lose sight of the noble ambition to provide equitable, timely end of life care and bereavement support for those who need this. Never losing sight that this kind of caring is what the majority of people want, need and will continue to require in the future

What if the morphine doesn’t work Are there no options to help the pain? Well here are some of the other options we use in palliative care. Oxycodone tablets, liquid, injection Alfentanil injection, spray Fentanyl patches, spray, lozenges Methadone tablets, liquid