Talking About Dying

The Oxford Healthcare Values Partnership is delighted to be partnering with the Collaborating Centre for Values-based Practice in Health and Social Care in promoting conversation about death and dying. To be able to talk about dying with insight and compassion is a vital characteristic of a wise society.

To that end, we helped to organise the following event in order to promote such conversation. The symposium was co-hosted by Oxford Healthcare Values Partnership and The Collaborating Centre for Values-based Practice in Health and Social Care.

Symposium - Thursday 16th November 2017 at St Catherine’s College, Oxford

We are particularly pleased that colleagues from Oxford University Hospitals NHS Foundation Trust, with whom we have been exploring the practice of compassion, played a leading role in the discussion on the evening.

The symposium followed the publication of “Talking about dying” by Philip Giddings, Martin Down, Elaine Sugden and Gareth Tuckwell. It involved a panel discussion with audience participation, moderated by Evan Davis, Journalist and BBC Presenter. Our host for the evening was Prof Ashok Handa. Panelists were Dr Graham Collins, Dr Elaine Sugden, Dr Joel Ward and Pamela Richards.

Discussion topics included:

• Who needs to talk about dying?

• Why don’t many of us like to talk about dying?

• What do we say?

• Involvement as a doctor/nurse/other health care professional

• Involvement as spouse, parent, family or friend

• Being the patient

• Does ‘faith’ make a difference?

• Practical matters: Wills, Power of Attorney, Advanced decisions

The following report (see below) was published in the Church of England newspaper on 23/11/2017.

Too Much Futile Resuscitation Say Oxford Medical Experts

Only a small minority of medics are of the view that trying resuscitation in every case should continue.

An Oxford conference last week was told that only one in 50 medics were of the opinion that resuscitation should be employed in every case except where a patient had specified their choice of ‘DNAR’ (Do not attempt to resuscitate).

The conference was told that deploying a crash team in every case of organ failure could cause distress to all involved.

The finding was one debated by 200 health care workers, priests, patients, relatives, economists, scientists and teachers gathered at St Catherine’s College last week. The “Talk about Dying” conference was sponsored by the Collaborating Centre for Values-based Practice in Health and Social Care and the Oxford Healthcare Values Partnership.

Professor Ashok Handa welcomed Evan Davies, presenter of Newsnight, to chair the discussion. Davies noted how the principal agent theory in which a salesman for an insurance policy is incentivized by money and so may well sell the wrong policy explains much that goes wrong in decisions about death.

He commented that the patient will only make the decision once, the relatives might defer to the doctors and the doctors want to ensure that they have done everything possible and in so doing fail to allow nature to take its course.

A panel started the conversation, opened by Dr Elaine Sugden co-author with Philip Giddings, Martin Down and Gareth Tuckwell of “Talking about Dying”, which was the catalyst for the event.

Mrs Pamela Richards, who is undergoing experimental treatment for a life-threatening cancer, spoke of the support of people praying for her, and how she thought the trial might do her some good and help other people. She was warmly applauded.

Joel Ward, a recently qualified doctor, said that, observing events in hospital, he believed thatthings went better when people had thought ahead about whether they wanted resuscitation and when they were treated by the same doctors throughout.

The conference heard that honest and productive conversations with patients and, where appropriate, their family and friends,promote a better death.The assumption among medical professionals that everyone wanted to prolong treatment was unhelpful even among younger people.

Dr Graham Collins, a haematologist on the panel, spoke of a patient in her 20s who, after several courses of treatment decided not to continue. He said that different metaphors were needed to describe people’s experience: a “battle against cancer” may be initially inspiring but the inevitable outcome means that everyone has been defeated.

There was universal approval for making sure that hospice places should be available to all when needed.“Making palliative care services available for everyone would be one thing I would change,” one delegate said.Others asked whether doctors should treat symptoms to prolong life or help prepare for a good death with loved ones around and out of pain.

Dying was not a failure, a bad death was, the conference heard.

A fascinating development was the emergence of the issue of “what comes next?” and “hope”. Hope did not necessarily depend on “Where there is life there is hope” which led to further unneeded treatment.

Philip Giddings asked: “What values underlie a positive outcome?”. Dr Collins noted that hope in life after death could transform the situation of a conversation.