Death and the planetary crisis
Richard Smith
Chair, UK Health Alliance on Climate Change
Cochair, Lancet Commission on the Value of Death
Our unhealthy relationship with death, the planetary crisis, the pandemic, and antimicrobial resistance all flow from our delusion that we are masters of nature not part of nature
Billions are being spent on the explicit pursuit of immortality, and is all medical research an implicit pursuit?
“The unconscious of every one of us is convinced of his own immortality.” Sigmund Freud. ��Does our comfort in living with death allow us to live in comfort as all life on the planet is threatened?
About 10% of annual health care expenditure is spent on the 1% of people who die in that year. As spend and carbon consumption are closely related about 10% of the NHS carbon footprint is on care in the last year of life, most of it in the last month.
The Carbon Footprint of the NHS
Are the money and carbon well spent?
Evidence for overtreatment at the end of life
In many countries, evidence exists for the overuse of aggressive care for dying patients and simultaneous underuse of appropriate palliative care
Despite evidence that most people around the world would prefer to die at home about half die in hospital
Inappropriately aggressive cancer care near the end of life has been identified as a common problem
Overuse of aggressive end-of-life care in the UK, for example, includes futile insertion of percutaneous endoscopic gastrostomy tubes and administration of chemotherapy that hastens death
Ineffective intensive care unit treatment at the end of life
A study from Korea found that most patients with terminal cancer received futile intravenous nutrition during the last week of life, with discussions of palliation in only 7% of cases
Evidence for the overuse of medical services worldwide, Lancet 2017
Rebalancing death and dying�from belonging to the health system to belonging to families and the community with health professionals as supporters not leaders
Reimagining death and dying: a realistic utopia
The social determinants of death, dying, and grieving are tackled
Dying is understood to be a relational and spiritual process rather than a physiological/medical event
Networks of care lead support for people dying, caring, and grieving
Conversations and stories about everyday death, dying, and grieving become common
Death is recognised as having value
And we aim to get end of life care to carbon net-zero as we must everything
“Rebalancing death and dying will depend on changes across death systems—the many inter-related social, cultural, economic, religious, and political factors that determine how death, dying, and bereavement are understood, experienced, and managed.” Lancet Commission on the Value of Death
What now: your take home message
What now?
Explore ways of implementing the recommendations of the Lancet Commission on the Value of Death (read the whole report)
Work with communities
Research
Advocay
Measure the carbon footprint of current pathways at the end of life and experiment with ways of reducing it (recognizing the need to think beyond the health system)
Establish a citizen-led transdisciplinary commission on getting end of life care to net zero (A job for UKHACC?)
Something you can do now: write into your will how to dispose of your body