Let’s Talk About Dying

On 16th November, the College hosted a symposium in the Bernard Sunley Lecture Theatre entitled Talking About Dying: The Biggest Question.

Following last year’s publication of Talking About Dying: Help in Facing Death & Dying (Wilberforce Publications, 2016), co-authored by Philip Giddings, Martin Down, Elaine Sugden and Gareth Tuckwell, the event aimed to facilitate discussion on a number of important questions on the subject, including: Who needs to talk about dying? Why don’t many of us like to talk about dying? Does ‘faith’ make a difference?

Organised by the Collaborating Centre for Values-based Practice in Health and Social Care (based at St Catherine’s College, with a management team including Professor Ashok Handa, our Fellow by Special Election in Medicine, and Fellow by Special Election Professor Bill Fulford) in collaboration with the Oxford Healthcare Values Partnership, the symposium followed the format of a panel discussion with audience participation, moderated by journalist and BBC presenter Evan Davis.

Professor Ashok Handa introduced the event by welcoming the 200-strong audience from a diverse range of backgrounds including medics, nurses and other healthcare professionals, lawyers, priests, teachers, and many more. He expressed his wish that the event would spark dynamic conversation, and with such a varied audience, that is certainly what followed.

Beginning the discussion, moderator Evan Davis mused that in a world where there is so much attention to birth, it seems strange that the same attention is not given to death. He remarked that in a conversation about death there are often three interested parties – the patients, the relatives, and the medics – all with differing feelings and incentives. Drawing on his experience as an economist, and considering the Principle-Agent Theory, he argued that the relationship between these three varying viewpoints seems like a recipe for disaster, and therefore the conversations just don’t happen.

The first panellist to speak was Elaine Sugden, co-author of Talking About Dying, who explained she had been reluctant to approach the subject of dying. However, after recognising the sheer lack of resources on how to deal with a situation in which a relative, or indeed oneself, is approaching death, she felt it needed to be done.

The second panellist was Graham Collins, a Consultant Haematologist with particular interest in Hodgkin’s lymphoma, a largely curable cancer which most typically affects young people. Graham commented on the importance of never assuming the patient and family are on the same wavelength; never assuming the patient wants to continue treatment; and engaging with and accepting that death is a natural process. He also spoke of the importance of the language used around death, highlighting for example that the metaphor of cancer being a ‘fight’ or a ‘battle’ is problematic when it comes to someone whose illness is terminal. Graham was followed by Pamela Richards, a patient of Graham’s undergoing cancer treatment. She talked about how thankful she was for the honesty with which Graham outlined her options, after her cancer did not respond to chemotherapy or radiotherapy treatments. Inspirationally, she explained that after deliberation, she decided to undergo experimental treatment in the hope that it might help her – but even if not, it might help others in the future.

(L-R: Prof Ashok Handa, Dr Joel Ward, Evan Davis, Dr Graham Collins, Pamela Richards, Dr Elaine Sugden. Image credit: Chris Sugden)

The final panellist was Joel Ward, junior doctor working in Colchester and alumnus of St Catherine’s. He expressed that recognition of someone approaching the end of their life is an important part of a doctor’s remit, and it is critical to be honest without causing undue distress. He noted that the most productive and least distressing consultations about death are always when the conversation has already happened between the patient and their family or friends, and that this has inspired him to take the first step in discussing his thoughts about death with his own family – adding that he has been surprised by how many others have been willing to open up following his example.

Evan Davis then opened up the floor to comments and questions from the audience, which were plentiful and of great variety. The ensuing conversation covered topics including whether treatment should be used in some cases not only to cure, but to ‘buy time’ to allow patients a means of mentally preparing for death; the value of and misunderstanding surrounding the Do Not Resuscitate order; and how faith and religion can change how the conversation about death goes.

In his closing comments, Evan summarised his key takeaways from the discussion: the importance of honesty in conversations about death, the value of advance preparations for death, and the importance of not using overtreatment as a means to give false hope to patients. All in all, it was an enlightening and insightful event, which Professor Ashok Handa ended by willing the attendees not to let the conversation about death end there – but to continue to discuss it going forwards with friends, family and colleagues.

(Header photo L-R: Prof Joshua Hordern, Dr Elaine Sugden, Dr Christopher Sugden and Prof Ashok Handa. Image credit: Richard Cave)