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Love in the time of coronavirus

This essay was published in the British Medical Journal (BMJ) in May 2020. The author is a retired GP.

In an essay written for the British Medical Journal in May 2020, Iona Heath spoke on behalf of older people. Acknowledging that the virus has hastened the end of life of many vulnerable older people, she made a plea for the kind of support that would make it possible for those who choose to, to remain at home as much as possible. In doing so she suggested that enhanced medical and social support is necessary to enable families to support their older relatives in this way.

Below is an extract from her essay. The full essay can be found here

Many older people, including myself, do not want to be admitted to hospital let alone to die on a ventilator or undergo cardiopulmonary resuscitation. We do not want to undergo distressing and invasive treatment with little chance of success, and we certainly do not want to use a ventilator that could be more useful to a younger person or to subject healthcare staff to the additional viral exposure involved in intubation.

Health professionals might find it difficult to respond to these attitudes because of a pervasive fear of being accused of ageism. Perhaps the coronavirus crisis can finally broker a shared understanding that a “do not attempt resuscitation” order is not a death sentence or the devaluing of a life but an attempt to ensure dignity in dying. Who wants to die with broken ribs and a minute chance of successful resuscitation when they could die peacefully in bed holding the hand of the person they love most?

Question: What do you think about the idea that the coronavirus might finally bring into awareness the importance of having difficult conversations with people nearing the end of life? In your experience, do we live in a culture where people can choose what matters to us, or is their a tendency to “resuscitate no matter what”?

The essay goes on to consider what might be most significant at the end of life:

Let us start with the presumption that no one should die of covid-19—or anything else—isolated from those they love and who love them. If we can agree to this, then we can approach the care of seriously ill people from a completely different perspective. Such a commitment is surely not beyond the wit and resources of a nation: fewer people admitted to hospital; much more support available at home and in care homes. Testing for those who want to be with their loved one and physical isolating after any risky contact. Without this, life partners, relatives, and friends are being deprived of the opportunity to say goodbye, to say the crucial things that need to be said at the end of life.

Even in the face of death, there is nothing more important than love.

Reflect on the week’s activities and consider whether or not you agree with the author, then read the whole article in preparation for next week.

To conclude Week 3, it would seem that, amid the sadness, confusion, loneliness, isolation and despair that have defined the experience of the pandemic for those most affected, what matters in the end for many families are their relationships and the love they have for one another.

See you soon for the final week.

© Tavistock & Portman NHS FT
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Grief, Loss, and Dying During COVID-19

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