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End-of-life care needs a fundamental review, not just more funding | Letters
Technology

End-of-life care needs a fundamental review, not just more funding | Letters

Your editorial (29 October) highlights the urgent need for better funding for end-of-life care. As a physician and academic who has worked in this area for 40 years, I would like to raise three underlying issues. First, it implies that hospices are the only model for delivering good end-of-life care. It is arguable that in Britain we have overrelied on the charitable sector. We now have NHS-funded hospital palliative care teams who can provide excellent care when patients are coming to the end of life but still needing specialist treatments – which very often hospices cannot or will not offer. In my evidence last week to the House of Lords select committee on the terminally ill adults bill, I pointed out that patients on average are referred to end-of-life services such as hospices only in the last weeks of life. And about 80% of these have cancer – other conditions causing death with equal amounts of suffering are hardly catered for. Second, increased funding for end-of-life care is likely to support the same imbalanced model, with its geographical and socioeconomic inequalities. It is easier to talk of more money than of fundamentally reviewing service models. Third, your editorial restates the fallacy of assisted dying being a competitor for funding against the hospice sector. There is ample evidence that in jurisdictions with legalised assisted dying, palliative care and assisted dying can exist side by side. Indeed, introducing assisted dying has often led to an increase in palliative care funding and referrals. The truth is that end-of-life care has failed to evolve in the 60 years since the opening of the first modern hospice and in the 40 years since we have had specialist palliative medicine. It could take for ever for hospice-based end-of-life care to achieve the funding it wants. And for ever is something that dying people do not have.Prof Sam H AhmedzaiEmeritus professor of palliative medicine, University of Sheffield Your editorial is absolutely right to urge greater commitment to palliative care services; my own specialty here in the Australian state of Victoria for 20 years. However, it misses a vital point: assisted dying is a complement to such care, not a competitor. (Subsequent letters (2 November) from leaders in the sector fail to mention assisted dying at all; somewhat surprising given the high-profile debate the UK is currently engaged in.) In Victoria, where voluntary assisted dying (VAD) has been available since 2019, I have supported more than 70 patients through the process. Every one of them received expert palliative care. Most wanted simply to know that, if their suffering became intolerable, they had another lawful option. They did not reject palliative care; they valued it deeply. But for a small number, it could not completely meet their needs in the final days. Experience here has shown that introducing VAD has strengthened, not weakened, our care culture. About 80–85% of people who use VAD are already in receipt of palliative care, and governments have responded with more than A$1bn (£500m) in new palliative-care investment since 2017. My specialty, historically sceptical of assisted dying, has experienced a significant shift in favour, at last recognising what our patients had long been telling us: palliative care and choice go hand in hand.Dr Greg MewettPalliative care physician, Ballarat Central, Victoria, Australia

Are you a perfect modern gentleman? Not if you run in public or wear a tank top to the gym …
Technology

Are you a perfect modern gentleman? Not if you run in public or wear a tank top to the gym …

Name: The Modern Gentleman. Age: Modern. Appearance: Goes to the gym but doesn’t wear a tank top. I’m sorry, but we’ve already covered this one. Did we? We did. In 2015, Country Life magazine created a list of the 39 attributes that make a modern gentleman, and we lightly pulled them apart, remember? Oh, no, this is completely different. You see, Country Life magazine has created a list of the 39 attributes that make a modern gentleman … That’s exactly the same! No it isn’t, because that was a decade ago. The 2015 rules are completely obsolete now. For example, one of them was “Cooks an omelette to die for” and another was “Is good with waiters”. Preposterously outdated stuff. Fine, so what are the 2025 rules? Well, one of them is: “Can poach and scramble eggs without fuss”. Another is “Learns and uses waiters’ names”. Oh wow, yes, extremely different. Listen, do you really expect a complete overhaul of the entire definition of gentlemanliness every single decade? Hardly. There’s something inherently timeless about being a gentleman, and that mainly has to do with cooking eggs and not being rude to restaurant employees. There must be something new, though. Oh yes – the thing about not wearing a tank top to the gym is one of them. Surely that’s less about being a gentleman and more about not wanting to look like a sweaty idiot. Or there’s this one: “Never runs for things in public”. Anything? What if your dog was chasing some deer through a park? If you’re a gentleman, you’ll remain at walking pace. The deer will appreciate your panache. How about this one: “Believes Roger Moore was the best 007”. That’s not gentlemanly, that’s just contrarian pub talk. And these: “Is pathologically punctual”, “Knows when to call it a night”, and “Doesn’t modify restaurant orders”. Actually, those do all sound quite reasonable. To be a modern gentleman is to be able to go about things with the minimum level of fuss. Efficient, friendly, confident – that’s what makes a gentleman. That and having a terrible opinion about long-running spy franchises. Well, yes, that too. But you must remember, the final rule of being a modern gent is: “Doesn’t take anything too seriously”. Consider me educated. Same time in 2035, then? Absolutely. Brace yourself for rules like “Doesn’t exclusively use AI to communicate with loved ones” and “Can smile at strangers regardless of their position on the class war that has definitely engulfed the planet by now”. And something about being able to cook an egg. Of course. Bare-minimum culinary skills never go out of style. Do say: “Hello, I am a modern gentleman.” Don’t say: “Fancy watching Dr No?”

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