The latest issue of Future Healthcare Journal has been guested edited by author, physician and campaigner Dr Kathryn Mannix. Here, she reflects on what a career in palliative medicine has taught her about dying, why it should never be seen as a medical failure, and why all physicians, regardless of specialty, need the confidence to talk more openly and earlier with patients about the final phase of life.
I trained and worked for many years in palliative medicine, a specialty that grew and matured during my own career. Along the way, I came to understand something that now shapes everything I do: dying is not a medical failure. It is the final part of living, and it deserves the same care, skill and honesty that we bring to every other phase of life.
In recent years, much of my work has focused on helping to normalise conversations about death and dying through writing, speaking and public engagement. I have seen how powerful it can be when people are given the language, confidence and permission to talk about dying before they are forced to. That is why I was delighted to be invited to guest edit this month’s RCP Future Healthcare Journal, which focuses on palliative and end of life care for physicians across all specialties.
This issue is an invitation to my medical colleagues. It is not about asking everyone to become a palliative care specialist. It is about encouraging all doctors to add palliative thinking earlier, to talk about dying with more confidence, and to plan for foreseeable deterioration or crises in genuine partnership with patients, long before the final days or weeks of life.
As physicians, we work to prevent illness, restore health, reduce the impact of long term conditions and promote healthy lives. But there is one truth that unites every specialty: our patients are mortal. Dying is not separate from medicine; it is part of our professional responsibility.
Good care at the end of life includes symptom control, but it also means preventing distress, restoring emotional wellbeing and helping people adapt to what lies ahead so that the last part of life can be lived as well as possible. These responsibilities apply regardless of specialty. Yet too often, they are postponed or avoided.
Many people living with progressive long term conditions do not understand that their illness will, eventually, lead to their death. We continue to frame conversations around ‘cure’ or ‘control’, rather than using the more honest language of progression, deterioration and limits to treatment. In doing so, we delay difficult but necessary conversations.
The result is that predictable crises come as a shock to patients and families. Clinicians recognise the patterns immediately – infective exacerbations of COPD, worsening heart failure, declining exercise tolerance in lung disease, advancing frailty – but patients often experience these moments as sudden and unexpected. When this happens, care becomes reactive rather than planned, and decisions are made in the heat of crisis rather than shaped over time.
This special issue of Future Healthcare Journal brings together perspectives from patients, community services, emergency medicine, intensive care and palliative care. Their message is consistent. We need to begin conversations earlier about the diminishing returns of aggressive interventions. We must help patients understand their likely future trajectory, so that they – not the clinicians meeting them for the first time in an emergency – can decide the limits of intervention they would choose. And we must become better informed about the process of dying itself, so that we can recognise it, describe it and respond to it well.
Failure to plan causes avoidable harm. It costs patients precious time, drives unplanned use of emergency services, leaves families unprepared, and leads to escalation that may offer little benefit. Avoiding a tender fifteen minute conversation is often paid for in weeks spent in hospital and deaths that come as a surprise.
We can do better.
I have encouraged the public to talk about dying before they need to. Now I am asking my medical colleagues to do the same. Talking about dying is not about giving up. It is about extending good care into every phase of life.
Except, of course, for immortals.
They can relax.
FHJ is a peer-reviewed RCP journal. It has editorial independence and the views expressed by journal article authors are not necessarily the views of the RCP.
Dr Kathryn Mannix
Author, physician and campaigner
