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BioEdge: An urgent need for palliative care as the world turns grey | BioEdge | Sunday, June 18, 2017 |

BioEdge: An urgent need for palliative care as the world turns grey

| BioEdge | Sunday, June 18, 2017 |

An urgent need for palliative care as the world turns grey

by Michael Cook | 17 Jun 2017 |

Is the developed world prepared for the avalanche of elderly people who will die of cancer and dementia? A report in the journal BMC Medicine says No.

About 75% of people approaching the end of their lives would benefit from palliative care services. But after crunching the numbers, researchers at the Cicely Saunders Institute at

King’s College London have concluded that England and Wales are woefully unprepared for a 42% increase -- 160,000 people a year -- requiring palliative care in 2040 as the population ages.

Healthcare systems must now start to adapt to the age-related growth in deaths from chronic illness, by focusing on integration and boosting of palliative care across health and social care disciplines. Countries with similar demographic and disease changes will likely experience comparable rises in need.

They point out that this is a world-wide trend. Even in developed countries, there is not enough access to palliative care, with the number of providers varying from 5 to 680 per million population. “Overall, only a minority who need palliative care, perhaps as low as 14%, receive it,” they note.

What is needed to prepare this situation? First, “a massive increase in training of specialist nurses and physicians” right now. Second, a huge increase in geriatric training for healthcare providers. “It takes at least 9 years to train a community geriatrician, and so workforce planners need to act now,” they point out. Third, a change in focus towards caring for patients with dementia will be needed.

Professor Irene Higginson, a co-author, says:

"There is an urgent need to act now to transform health, social and palliative care services to meet the projected growth in palliative care need. More attention should be given to the needs of people and those close to them when facing progressive illness, particularly those dying from chronic and complex illnesses, and age related syndromes such as frailty and dementia. There is a need to support their families, who shoulder so much of the care. The way in which we provide health care, and palliative care will need to change.”

Unmentioned by the researchers is the impact of this grey wave on end-of-life debates. Unless the sick and elderly are well cared for at the end of their lives, legalised assisted suicide and euthanasia could very well seem like a plausible and cheaper alternative.

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Sunday, June 18, 2017

A Massachusetts woman has been found guilty of involuntary manslaughter in a case which was reported across the United States and could affect the debate about assisted suicide.

In 2014 Michelle Carter, then 17, used phone calls and text messages to bully her boyfriend, Conrad Roy III, 18, into asphyxiating himself in his car.

Their relationship was a bizarre one. Although they lived only an hour away from each other, they met in Florida on family holidays. Thereafter they only met each other a handful of times. But they texted each other incessantly, especially about Roy’s desire to kill himself. Ms Carter encouraged him.

However, when he was sitting in his car and the fumes were building up, he got out, clearly wanting to live. She instructed him to get back in. He did and he died.

There are two schools of thought about Ms Carter’s bullying. Most people would agree with the judge that she had a duty to try to save Roy’s life and acted in a “wanton and reckless” manner.

But others, while acknowledging that her words were reprehensible, point out that Massachusetts has no law against assisted suicide and that words are not bullets. They argue that her incitement was protected free speech.

The American Civil Liberties Union has yet another reason why Ms Carter should have been acquitted: “If allowed to stand, Ms. Carter’s conviction could chill important and worthwhile end-of-life discussions between loved ones.” In other words, this throws sand in the gears of legalising assisted suicide.

What do you think?