Death also reminds us of our fragility and sameness: we all die.

Death and life are bound together: without death there would be no life. Philosophers and theologians from around the globe have recognised the value that death holds for human life. Health care and individuals appear to struggle to accept the inevitability of death. Large sums are being invested to dramatically extend life, even achieve immortality, for a small minority in a world that struggles to support its current population. This situation has further fuelled the fear of death, reinforcing the idea of health-care services as the custodian of death.Ĭlimate change, the COVID-19 pandemic, environmental destruction, and attitudes to death in high-income countries have similar roots-our delusion that we are in control of, and not part of, nature. People have died the ultimate medicalised deaths, often alone but for masked staff in hospitals and intensive care units, unable to communicate with family except electronically. The COVID-19 pandemic has meant that death is prominent in daily media reports and health systems have been overwhelmed. Death and dying have become unbalanced in high-income countries, and increasingly in low-and-middle-income countries there is an excessive focus on clinical interventions at the end of life, to the detriment of broader inputs and contributions. The roles of families and communities have receded as death and dying have become unfamiliar and skills, traditions, and knowledge are lost. Futile or potentially inappropriate treatment can continue into the last hours of life. Death and dying have moved from a family and community setting to primarily the domain of health systems. Death comes later in life for many and dying is often prolonged. How people die has changed radically over recent generations. The unbalanced and contradictory picture of death and dying is the basis for this Commission. While many people are overtreated in hospitals with families and communities relegated to the margins, still more remain undertreated, dying of preventable conditions and without access to basic pain relief. The story of dying in the 21st century is a story of paradox.

Fit to be Dead by Nancy G. West