[Magdalen] RIP Sir Terry Pratchett

[Roger Stokes]

------ Original Message ------
From: "ME Michaud" <michaudme at gmail.com>
To: "magdalen at herberthouse.org" <magdalen at herberthouse.org>
Sent: 12/03/2015 22:43:23
Subject: Re: [Magdalen] RIP Sir Terry Pratchett

>My nderstanding (and I could be wrong) is that the British are
>much better at end-of-life care than we are. We've talked about
>DNR orders being routinely ignored here. And I think we talked
>about the pacemaker conundrum here also.

The concept of Hospice care started in Britain with Dame Ciceley 
Saunders in the 1950's who qualified, in succession, as a nurse, social 
worker and doctor.  The first dedicated hospice opened in London in 
1967.  The aim is to give holistic care, including emotional and 
spiritual care alongside the medical.  The aim is to allow the 
individual the best possible quality of life at every stage of a 
life-limiting condition. Hospices, both for day-care and for inpatients, 
are now a part of British life but they still rely heavily on voluntary 
fund-raising to complement what the government funds.

I do not claim for one moment that we have end-of-life care sorted out.  
Until a few years ago we had what was called the Liverpool Pathway (Joan 
was put on it, and I believe it was appropriate for her) where purely 
palliative care to keep the patient comfortable as nature takes its 
course.  That was stopped after concerns that it was being used 
inappropriately in some cases where the condition was not necessarily 
terminal.  A few weeks ago the local hospital chaplain spoke to our 
clergy chapter and said that discussing end-of-life plans is still 
something that many doctors feel uncomfortable about and will not 
address directly.  She and I believe that is wrong.  We all have the one 
condition with 100% mortality - it's called life.

As you imply we have considered before situations where medical 
intervention is basically futile and, I would add, depriving the patient 
of their intrinsic human dignity.  I believe the hospice philosophy has 
much to offer to medicine in its recognition of reality and affirming 
the dignity of the patient at all times, providing emotional support to 
their loved ones as well.  On this list we have (at least) one person 
receiving hospice care (Brud Jon) and the husband of another (Jim).  
Jon's post today about his retirement epitomises for me the essence of 
appropriate care - recognizing his calling as a deacon even when he can 
no longer exercise it in any active way.  Jim's Marcy's condition 
strikes me as being particularly hard as her body refuses to do what she 
wants it to do and so she has to rely on others for intimate care.  I 
pray that while Jim is away in Hawaii Marcy receives a more holistic 
care away from the memories of how their home has had to be adapted 
(very well in my view having seen it) and the inevitable rebalancing of 
the husband-wife relationship.

Roger
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