Dying Safely

The burden of deaths due to noncommunicable disease, particularly in the elderly, is projected to rise from 59% in 2002 to 69% in 2030. The ageing population has increased the use of medical technology and life support systems for the support of elderly complex cases—the so-called “sick elderly.” Public expectations believe modern medicine and its associated miracles can prolong life almost indefinitely. Sophisticated technology and the way media portrays the latest miracles generates unrealistic expectations by relatives and often causes potential conflict at the end of life (EoL). The medicalization of death and dying, despite its inevitability has contributed to the disappearance of the concept of a dignified natural death. Dying and death are seen as the ultimate challenge for successful ageing or as a failure of medicine if doctors cannot offer hope of recovery. Unfortunately, in many terminal cases, efforts are made to prolong life under pressure from families as well as the culture of acute hospitals and their concentration on “curing.” Clinicians are often reluctant to recommend limitations of treatment and instead, often administer inappropriate treatment in the face of futility.

This chapter is not about assisted dying, euthanasia, nor about the “right to die.” It is about recognition of dying by clinicians; acceptance of death as a natural part of the cycle of life; understanding what constitutes a “good death”; considering the ethical aspects of futile interventions; and reviewing best practice in providing quality of EoL. We discuss the role of doctors, nurses, and the health system in supporting patients and family through the transition.