Dr Luke Evans is a member of the Health Select Committee, and is MP for Bosworth.
It may have been Benjamin Franklin who first introduced the widespread use of the idiom about ‘death and taxes’ but frankly at this time it doesn’t really matter.
All of us know that there are only two certainties and yet not just in Westminster, but in life too, whilst we wax endlessly about one, the other remains taboo.
There is nothing so certain or so natural as death, and the practice of medicine is central to how we manage it. As a doctor, like all practitioners, I work hard to prevent premature and untimely deaths; but I also help those nearing the end of their lives to have a comfortable, pain-free, good death.
This Coronavirus outbreak has brought us face to face with daily death tolls in the hundreds, and for many lockdown has brought the time to contemplate our own mortality; that is just as true for parliamentarians as anyone else. The truth is that we are talking about death now more than we have in years, for many of us perhaps more than we have ever talked about it.
Because it is a notifiable disease, we are hearing that, each day, hundreds of people are dying whilst infected with Coronavirus. According to Office of National Statistics for March this year, whilst 86 per cent of those deaths had COVID-19 assigned as the underlying cause, in 91 per cent of deaths from Coronavirus there was also at least one pre-existing condition; there’s no reason to expect that trends will differ significantly in later months.
What that means, though, is that in the significant majority of COVID-19 deaths a victim would already have been having their chronic conditions managed by a medical team playing a role in preventing untimely death, but also helping to deliver that good death when the time comes.
It goes without saying that palliative care is every bit as important as other areas of medicine for those nearing the end of their life and infected by Coronavirus.
Last week at the Health and Social Care Select Committee, I questioned the Secretary of State on the Government’s preparedness to deliver outstanding end of life care in both care home and residential settings.
Whilst ventilators are absolutely vital, it’s also true that the vast majority of people in those settings and approaching end of life will never need such an invasive intervention. Why? Because they have a what clinicians call “a ceiling of treatment”. In essence, taking them to an ITU setting would be literally futile. What is therefore essential is adequate staffing, equipment and pain medication – not to mention quality communication and of course access for loved ones at a deeply traumatic time.
Whilst it was pleasing to hear the Minister’s reassurances about my concerns, we must not lose sight of the need to give the very best medical care to those nearing the end of their lives.
It’s important to place Coronavirus in context. Admittedly, whilst March was the first month in which COVID-19 was recorded as a significant cause of death, and figures over the last month have obviously worsened, in only eight per cent of the 47,358 deaths that occurred in England and Wales did the doctor certify Coronavirus as a cause. We were far more likely to die for another reason, overwhelmingly during our old age.
As a constituency MP, a doctor, and a community leader all of this matters tremendously. It matters because no matter the cause of death, whether Coronavirus or not, our role is to advocate for the best death for everyone.
We will all lose a loved one at some point in our lives and ensuring their death is comfortable and without distress, with their wishes respected, is paramount.
One of the jobs of parliamentarians during the coming months is to ask: what all that means in the context of Coronavirus and its eventual legacy?
We have to create an environment which makes it not only acceptable but desirable to discuss our wishes for care when we are unwell: whether we wish to sign a DNAR form? The level of treatment we might consider? How we want to die? And whether we want to be buried or cremated?
Preparation for events is key, each and every one of us should now be thinking in a positive way about what will be coming to us all.
It’s important that we harness any positives that have arisen from this terrible period in our history. There aren’t many, but it is essential to give purpose to those lives lost prematurely.
I very much hope that one of those positives is a mature, open conversation by the public and professionals about helping the dying through their final days. It’s time that talking about death becomes something which is acceptable, and not just the unspoken cousin in a 300-year-old idiom.