Featured Article

2017; Volume 18, No 2, February

Featured Article

Dr. Doyle receiving the honorary degree of Doctor of Science from the University of Glasgow in July 2014. Photo: Courtesy of Glasgow End of Life Care Studies.

Founding and lifetime member of the IAHPC, Dr. Derek Doyle, O.B.E., is our guest writer this month

Throughout the year, IAHPC board members contribute a range of opinion pieces and other thought-provoking articles to the IAHPC Newsletter. Now it’s the turn of Dr. Derek Doyle whose immense contribution to the field of hospice and palliative medicine has been recognized throughout the world.

Palliative care: The end of the beginning or the beginning of the end?

It is only 50 years since St. Christopher's Hospice in London opened. A few others had opened earlier in the 20th century but St. Christopher's is generally regarded as the inspiration for many of today's 16,000 palliative care units and services in the world (WHO 2016). Will this rate of growth continue and (dare one ask), will need and demand merit such growth? Will educational resources be adequate so that, as today, palliative medicine will be taught in all medical schools with more than 60 Chairs of Palliative Medicine. Not only has it become a medical and nursing specialty, many books on different aspects of it have been published as well as many international research journals.

The need for the original hospices/specialist palliative care units is well documented – meeting the needs of those dying with poorly controlled pain and little or no dignity, the ‘conspiracy of silence’, the needs of relatives, the well-recorded sense of helplessness reported by doctors, the almost complete absence of any professional training in care of the dying and support of relatives and friends.

If we compare palliative care (a name that embraces all the disciplines involved in such care) with human growth and development we are surely justified in saying we have successfully come through infancy and childhood, but may not yet have come through the ups and downs, the laughs and the tears of adolescence. We can celebrate the worldwide interest in it, the support of the World Health Organization, the newfound confidence in offering good palliative care of so many general practitioners – a success story of which so many can be proud. Yes, we are probably at the end of the beginning. But are we at the beginning of the end? Will we see another 50 years?

Some will be taken aback by such a question but there are many reasons for taking a long, hard look at where we stand today. For example, are we satisfied that every medical and nursing student is not only visiting his/her local hospice but being taught the fundamentals of palliative care, especially emotional care, team working, social, cultural and spiritual needs and how they are addressed? It is probably safe to say that much, if not all, of this teaching will be done by palliative care specialists. Are we ensuring that these teachers will have been taught how to teach, how to set examinations, how to support their students?

Crucially, the training must be in the ‘principles of palliative care’ and not the minute complexities that need be known by, and demonstrated by, specialists. There must never be a day when we do not remind our students and colleagues that palliative medicine is not, nor ever must become, an exercise in analgesic prescribing.

There used to be a saying in my university: ‘If a medical student is not asked about a subject in his/her examinations, be they written or oral, the student will know it is not an important subject!’ I dread palliative medicine being seen as ‘soft’ – ‘an ideal subject for female doctors but not comparable with the excitement and emotional demands of operative surgery or emergency medicine’.

Can we be confident that training in the provision of the best possible palliative care will not end with graduation but become a feature of post-graduate training, whether that be as a physician, a surgeon, a general practitioner (GP) or a nurse specialist? Readers will not need reminding that most of the United Kingdom's medical/surgical Royal Colleges teach many colleagues from overseas. How exciting for them to learn palliative care in the country where it started, where it first gained specialty status and where receiving the best such care is seen as a basic human right.

Dame Cicely Saunders founded St Christopher’s Hospice in 1967. Credit: St Christopher's Hospice

It is so obvious that it may be thought unnecessary to remind readers that every member of the human race experiences dying and death. Palliative medicine and all its related subjects and aspects are not for the minority but for us all as this life comes towards its end. As greater people than the author have said repeatedly:

"Palliative care is as much about living as about dying, as much about today as about tomorrow, as much about loving as being loved."

If this is not done, today's palliative care will still be remembered and talked about, but in the context of history! At this time, when St. Christopher's is celebrating 50 years of sharing a dream, let each of us look long and hard at whom we serve, how we respond to need, how well we are teaching and enthusing those who will follow us. How shall we measure if we are succeeding? When every university and Royal College expects candidates to demonstrate an in-depth understanding of palliative care. When each palliative care unit has a waiting list of GPs/family doctors eager to attend intensive courses enabling them to cope with most of the challenges they encounter. It is impossible to know how palliative medicine will change when most new specialists will be women, when fewer male doctors are coming into specialist training, as is now happening. Much depends on the skills, the vision and the wisdom of today's leaders.

Whether or not our grandchildren will be able to access the highest quality of palliative care (or indeed any care) 50 years from now depends on the leaders of today. Will society, 50 years from now, be even more secularized and hedonistic than it is today? Will we all die in a hospital? Will some of today's hospices become museums, and GPs become a dying breed? Being a leader or a pioneer is always exciting, usually rewarding, but seldom easy! Thank you St. Christopher's!

More about Derek Doyle

Dr. Derek Doyle is recognized for his outstanding contribution to the development of palliative care in Scotland, the rest of the UK and throughout the world. He was founding President of the Association of Palliative Medicine of Great Britain and Ireland and the first consultant specialist in Palliative Medicine in Scotland. He established and was senior editor of the Oxford Textbook of Palliative Medicine and was the first Vice Chairman of the European Association for Palliative Care and first Chair of the European Committee for medical education and training in palliative care.

We are honored that Derek is also a founding and lifetime member of the IAHPC – read his bio here on the IAHPC website.

You can read more personal reflections from Dr. Doyle on the University of Glasgow End of Life Care Studies blog.

Editor’s note

For news of two UK conferences that have relevance to this article, please visit the Announcements page.

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