Globally, health and social systems are failing to provide adequate and compassionate care to dying people and their families. Millions of people suffer unnecessarily due to the current emphasis on aggressive treatments to prolong life, global disparities in access to palliative care, and high costs of end-of-life care. The Commission recommends a compassionate community model where communities and families collaborate with health and social services for the dying. As a result of the COVID-19 pandemic, many people have died alone, communicating with family only through digital means.
Over the past 60 years, health systems have taken responsibility for dying. Most end-of-life care is provided in hospitals in the UK. Health care has alienated families and communities. People are more dependent on health systems because of this loss. Despite this, discussions of death and dying are often complex and stressful.
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The Commission sets out five principles of a new vision of death and agony:
1. To live healthier lives and die more fairly, we must address the social determinants of death, dying and bereavement.
2. Relationships based on connection and compassion are prioritized and placed at the heart of the care and support of people who are dying or grieving.
3. Professionals need to be included in care networks for the dying, care and bereavement.
4. Conversations and stories about everyday dying, dying and bereavement can help spark wider public debate and action.
5. Death must be recognized as having a value. “Without death, every birth would be a tragedy.”
To achieve the widespread changes needed, the Commission makes key recommendations for policy makers, health and social care systems, civil society and communities, including:
- Education about death, dying and end-of-life care should be essential for people at the end of life, their families and health and social care professionals.
- Increasing access to end-of-life pain relief must be a global priority, and the management of suffering must accompany life extension as a research and healthcare priority.
- Conversations and stories about everyday dying, dying and grieving should be encouraged.
- Care networks should lead support for dying, caring and bereaved people.
- Patients and their families should be provided with clear information about the uncertainties as well as the potential benefits, risks and harms of interventions in life-threatening diseases to enable more informed decisions.
- Governments should create and promote policies to support informal carers and paid compassionate or bereavement leave in all countries.
Source: The Lancet