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End of life care

Updated Tuesday, 29th September 2009

Richard Wilson interviews palliative care nurse Deborah Murphy about the privilege and challenge of caring for people at the end of life

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Richard Wilson: I suppose a lot of the time you’re dealing with the patient in the moment of death.

Deborah Murphy: Certainly in the run up to and the last hours and days of the end of life, yes, people who are dying.

Richard Wilson: Right, and did you, how did you train first of all, how did you get in to palliative care?

Deborah Murphy: I guess for nurses who work within palliative care, they do advanced training over and above their general training, usually in oncology, in cancer services, with extra training in care of the dying. For me, I got into it, I’ve been working in palliative care in various guises for about the last fifteen or sixteen years and it’s just, it’s an absolute privilege to do my job.

Richard Wilson: Yes, so I suppose most of the patients know they’re dying?

Deborah Murphy: The majority of patients do know they’re dying. There are some patients who don’t because that’s they’re choice. There are some patients who don’t realise that they’re at the end of their life and that’s one of the reasons that myself or a member of my team would be asked to meet them to have and enable some of those difficult conversations.

Richard Wilson: So your job in a sense is to guide them through what dying is about?

Deborah Murphy: That’s certainly one of the roles that we play, yes.

Richard Wilson: And do you find that that helps them? Well, obviously.

Deborah Murphy: Yes, I think that most people like information and to know exactly how things are. The majority of patients and carers that I see would actually choose to know what was going on in their lives. Many people have arrangements they would like to make, things that they would like to do, many people would choose to arrange their own funeral and plan for the last hours and days of their life, and part of our job is to enable that to happen.

Richard Wilson: So presumably the time they have is going to vary a lot?

Deborah Murphy: Yes, I think for some patients they’re living with their illness, not all the patients we see have a cancer, it can be any health issue, and for some of those patients they are expecting to die and death can be quite imminent. For some patients, we might have known them for a longer period of time and they have a gradual deterioration in their health. Most of the patients we meet would choose, if they had that opportunity, to plan for their death. Some patients would choose to die in hospital, some patients would choose to die at home or in the hospice, and part of our role is to enable that, as far as possible, as well.

Richard Wilson: Not so many people die at home now, is that true?

Deborah Murphy: No, it’s absolutely true. The majority of patients, something like 56-58% of patients, are dying in our acute hospitals. I think that, and there is a big push nationally, certainly in the UK, to enable more people to die in the place of their choosing. And for many people that would be at home, but many people would choose to die in hospital and I guess it’s important, not just the location of where you die, but what’s perhaps more important is the care that you get and the quality of that care and that your death is as dignified as possible. And that can happen in hospital just as at home.

Richard Wilson: And when you’re talking to patients do you use the word, "dying"?

Deborah Murphy: I do, and we as a team think it’s very important that language is used appropriately and euphemisms, whether they are, that avoid talking about death and dying and use that language, or medical terminology, perhaps, that doesn’t actually use the word "dying" is unhelpful sometimes and that most of the people we meet would like to know exactly what was expected of them, and if they’re dying they would like to know that.

Richard Wilson: Would you say that, by and large, the moment of death is always a peaceful moment?

Deborah Murphy: I think for the majority of patients the moment of death is peaceful, but there are always examples of people who don’t die a good death. Sometimes that can be their choice, sometimes it’s a cultural or a religious belief for some people, they would prefer to have some degree of pain or discomfort at the end of life because, if there is a possibility of an afterlife, that that’s important to them. But I guess the most important thing in that situation is that’s that individual choice that you’re working with and that’s their choice and you would respect that. But for the majority of people whose death can be viewed as expected and the death isn’t sudden then it is certainly possible to ensure for the majority of patients that that death is comfortable, and usually that person drifts into a protracted sleep and dies very peacefully.

Richard Wilson: Hmm-mm.

Deborah Murphy: If the last hours and days of life have been managed effectively and well and as far as possible that death is as dignified as it can be, then it certainly makes life easier for the person who’s going to have to live on afterwards, who’s left behind, to create some sort of positive memories of the experience that they’ve been through. And I think, the more appropriate and the more comfortable and restful that death has been, then a relative and carer copes much better and has less problems into bereavement.

Richard Wilson: Having dealt with death for so long, would you say that you were less afraid of death yourself?

Deborah Murphy: I’m not afraid of death at all. I am, I’m not convinced yet, which is partly why I do the job that I do, that the care that I will get or somebody I loved in the last hours and days of life is as good as it can be yet, that’s what - I think we’ve made great strides in recent years. But my mum died four years ago and had a very good death, a fabulous death in many respects. My father who is still alive but believes that death for him will be exactly as my mother’s was, that’s what he believes he’s entitled to and could expect. Can I guarantee that for him? At the moment no, I don’t think I can. And so that’s what we’re working towards, and that’s, I think, why it is more important for me to know that, wherever you do die that the care you get is as good as it can be and, if that’s in hospital and that’s where the best care is for that moment in time, then so be it.

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