‘Sorrow that finds no vent in tears may make other organs weep’

Sir Henry Maudsley, 1835 – 1918

 According to the British Pain Society, almost 10 million Britons suffer pain almost daily resulting in a major impact on their quality of life and more days off work at a cost estimated at around £5billion per annum, with around 20% of all new consultations involving pain. Long term pain is both disabling and distressing. The story of Gill Pharoah, a former palliative care nurse who passed away at the age of 75 at an assisted dying clinic in Switzerland in 2015 with chronic back pain raises important questions about euthanasia and the traumas that can come with old age not just in the context of terminal illness, but also for conditions which can ruin people’s quality of life. It also raises important questions about ageism and how society values elderly people.

Sue Lillyman, IAH Trustee

With dementia noted as the leading cause of deaths in England and Wales in 2015 (Office of National Statistics 2016) and with approximately 860,000 people living with dementia, which is still estimated to rise to 1,142,677 by 2025 (Alzheimer’s Society 2014) there is a need for people to discuss, prepare and provide optimal care for people with dementia at the end of life. Everyone has a fundamental right to die with dignity, be safe and protected from harm (DoH 2013) but, as noted by some researchers, the traditional palliative care model used for many other long-term conditions does not fit people dying with, and from, dementia (Bloomer et al 2011). Therefore, it is timely that we review specific needs for this group including behavioural concerns, discussions in relation to preparing for end of life, difficulty re placement of care, carer burden and over burdensome and/or under treatment in our discussions and education (Torke et al 2010).

Peter Mayer MA FRCP

There are many opportunities to be involved in improving patient services and developing the future in health and social care and research within many countries and this is central policy in the UK. Any locality will have many forums in commissioning primary and secondary care as well as national and local government groups.