Liam Farrell: Healthy? You should be planning for death

Death gets a bad rap, but in the late and much lamented Sir Terry Pratchett's wonderful Discworld novels, Death is humanised.

Perhaps a bit stereotyped – hooded, skeletal, carries a scythe, speaks in a sepulchral tone – he also struggles with the same doubts and uncertainties as the rest of us. And Death would be even more confused by the conceits of modern medicine.

Life used to be so simple – you’re born, you live, you die. But it’s more complicated now – you’re born, you live, you die, you get CPR, you may or may not die, or end up with a few broken ribs and some hypoxic brain injury, you tweet about it, then you die again, and get CPR again, and so on and so on.

Sir Terry’s Death would be getting restless, having to hang around for 10-20 minutes twiddling his bony fingers. ‘Give the poor guy a break, I’ve got others to see,’ he’d be saying.

And when does death really occur? When the senior doc says: ‘That’s it,’ an archetypal example of performative utterance; we’re dead because the doc says we are.

As Tennyson said: ‘Old men must die, or the world would grow mouldy.’ When our time’s up, we should depart gracefully, hopefully leaving a lot of bad debts for future generations to worry about; after all, what have future generations ever done for us?

Death may be the end of the journey, but what really matters is the journey. It’s not a defeat, but viewing it as a defeat leads to some of the worst excesses and abuses of modern medicine. This isn’t solely our fault; pressure from well-meaning relatives and the inertia of medical bureaucracy only serve to paralyse our attempts to do our best for our patients.

But we should take back that duty, make a stand. The buck stops with us and legal niceties shouldn’t prevent us from making the call in our patient’s best interests. What’s right and what’s necessary aren’t always the same thing.

Death is an uncomfortable subject, but encouraging patients to investigate and sign an advance care directive would strengthen our hand. And it would be better to do it while they are still healthy, so we’re not seen as attempting to hasten the transition to the choir invisible. Next week: Satan, not such a bad chap.

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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