The Dying: Individual Need or Professional Prerogative?
In: Death, Dying, Culture: An Interdisciplinary InterrogationSearch for other papers by David MacKintosh in
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In 2009 The Telegraph, UK, published a letter criticising the use of the ‘Liverpool Care Pathway’ as part of the NHS ‘gold standard’ in care of the dying, by implying that its use ensured that ‘the inevitable outcome… is death.’ The letter was generally dismissed by the palliative care community. Two outcomes of this event, however, are worthy of note. First, the assessment process in the Liverpool Care Pathway (Version 12) was amended to provide a more considered approach to the diagnosis of impending death; and secondly, The Telegraph published, online, close to 450 replies, the vast majority from the general public. Of these, 35% seemed to be in agreement with the concerns expressed in the article and letter, 15% disagreed, and in 50% it was not possible to discern a clear opinion. The response of the health professions in dismissing the letter and online replies fails to acknowledge the social importance of the document as an expression of the feelings and beliefs of the individuals we serve. It is suggested that the dying continue to be processed in a manner dominated by the professions’ views of what constitutes an appropriate dying rather than listening to their wishes. Furthermore, it can be argued that the palliative care movement has made a significant contribution to this, particularly in inappropriate normalisation of death – other people’s death, that is. The dominance of death in the management of the life of the dying, as opposed to the relief of suffering, can be seen as a product of a diminished recognition of individual need. This chapter discusses some of the influences involved and the need to reassert the needs of the dying individual against the competing demands of dominant ideologies and professional power in the dying process.