Death has been “overmedicalised” and millions around
the globe are suffering unnecessarily at the end of their lives as a result,
with healthcare workers in wealthy nations seeking to prolong life rather than
support death, according to an expert panel convened by the Lancet medical
At the same time, around half of people globally die
without any palliative care or pain relief, particularly in lower-income
The Lancet Commission – involving patients, community
experts, philosophers and theologians as well as experts in health and social
care – are calling for change.
“How do we create a balanced way to support
people as they are dying?” Commission co-chair Dr Libby Sallnow, a
palliative medicine consultant and honorary senior clinical lecturer at
University College London, said in an interview. “At the moment we are not
managing it as we could be.”
Although the Lancet Commission’s work began in 2018,
Dr Sallnow said the extremes seen during the pandemic had given it a new focus.
She recalled treating COVID patients at home and in
hospital during the pandemic, with those in hospital able to access
therapeutics and pain relief, but only able to speak to their loved ones via an
iPad held aloft by medical staff. Conversely, patients at home had their loved
ones with them, but often struggled for medicines to ease their suffering.
Sallnow acknowledged that infection control measures
early on in the pandemic had made it difficult to deliver care in a
“In the first wave of COVID, people were trying
to respond to something entirely unknown. But quickly the world realised that
it is not okay not to have people you love with you when you are dying,”
The commission had five recommendations for what they
called a “new vision of death.” First, tackling the social
determinants of death, dying and grieving, to allow for healthier lives and
more equitable deaths.
They also recommend that dying should be seen as more
than just a physiological event, and as such, networks of care must include
families and communities as well as professionals. Conversations about death
must also be encouraged, and death itself recognized as having value, they
The commission’s work focuses on life-limiting illness
or injury, rather than sudden or violent deaths, deaths of children, or deaths
due to injustice.