Give death and dying a little ReSPECT

On Monday morning I saw ‘Bill’. He was pretty fed up. Ex-military, 85 years old and getting increasingly frail with a number of significant health problems, notably heart failure. In days gone by he was a fit, active man and independent, so he is getting increasingly frustrated by limitations on what he is able to do these days. ‘I don’t want to be resuscitated - I’d like you to add that to my notes’, he said mid-consultation. This in itself would have been a quick and easy thing to do, but it was clear that a wider discussion about ‘Bill’s’ prognosis and end of life care needed to be explored. Time to consider ReSPECT.

Death and dying - a difficult conversation?

If we were to ask a cross section of health care professionals how they find discussing death and dying, there will inevitably be a range of views, but I suspect words such as ‘tough’ and ‘difficult’ may well be used. Why is this? Given one of the few certainties in life is that we will all die at some point, it is curious that we live in a society where discussions about death seem to get pushed to one side. ‘Memento Mori’ (‘remember you must die’) is not a phrase used much these days. Indeed ‘death’ and ‘dying’ are words increasingly absent from our vocabulary - euphemisms such as ‘passed on’ are increasingly the norm. Although the sands do seem to be shifting. Wherever you sit in the debate on assisted dying, one of the benefits has been a wider public discussion about death, how we want to die and the crucial importance of good palliative care.

Addressing death is a positive for life

In his very thought provoking book ‘Carpe Diem Regained’ the social philosopher Roman Krznaric argues that one of the things we need to do to live a happy and fulfilling life is to get more in tune with death. He discusses ‘death tasters’ - ways to reconnect with death to help regain some ‘carpe diem’. A similar theme was explored by Matt Morgan in the BMJ recently (BMJ 2025;388:q2884) when he talked about gifting his family and friends a ‘living funeral’ where he points out ‘But our living funeral wasn’t really about death—it was about life.’ The point being is that discussing death does not have to be the difficult topic it its often perceived to be - it can be life affirming. As we all know, if done well in a GP consultation, it can be a positive experience for both patient and clinician. 

ReSPECT discussions

I think the advent of the ReSPECT process and form has been incredibly positive. If you’re not familiar with it, I would strongly encourage you to explore this on the Resus UK website here. It allows patients an opportunity to explore what is most important to them in terms of their care, what they would wish to avoid, and resuscitation. ‘Bill’ was pretty skeptical when I first brought this up, but once I’d reassured him this was just a ‘guide’ to help us deliver what care he would (and would not) want, he was much more positive. It also allowed him and his wife to discuss a few things they had not really wanted to discuss between the two of them on their own. 

All in all it was a really positive consultation, ‘Bill’ and his wife were very thankful for the opportunity to discuss what was important for ‘Bill’ and were particularly reassured that this information would be shared with the wider local healthcare services.

If you need some help on discussions about death and dying and the ReSPECT process do join Rachel and myself on the Palliative and End of Life Care live webinar on Thursday 26th June. We will discuss how to address those discussions, as well as look at prescribing (and de-prescribing) at the end of life including syringe drivers, how to manage common symptoms at the end of life, as well as addressing some palliative emergencies. We hope to see you there!