ALTHOUGH everyone knows that death is inevitable for all, the subject of dying and death is still a taboo topic; as ‘sex’ was until recently.

Our politicians are discussing the topic regularly, especially the issue of ‘assisted death’ on which some are preaching ‘immortality’ — no matter how hopeless the condition and how intolerable the state, everyone must continue to exist somehow.

I do not wish to comment on this, this is a very controversial issue on which there will probably never be an agreement.

The topic I want to write about is ‘death’ itself and perhaps for a somewhat better understanding of this inevitability.

I would argue that ‘death’ is just not the absence of life it is a different state about which very little is known and more importantly, planned. Let’s now look at this ‘event’ more carefully and see if anything can be done to make it more ‘comfortable’.

Every year about half a million people die in England,three quarters of which are not sudden and are therefore ‘expected’. One can then sensibly conclude that the quality of life ‘immediately before death’ can be improved in about 33,5000 people each year in this country.

The recently published report by the Parliamentary and Health Service Ombudsman ‘Dying without Dignity’ has identified many shortfalls in the ‘end-of-life-care’ for many.

Poor pain management, inadequate out of hours services and communication failure with the families are some of them.

The well known Macmillan Support services chief has commented: "This report cites heart breaking examples of a lack of choice at the end of life; this is totally unacceptable.’’ It is therefore, essential to improve the ways of care for such individuals with better and greater coordination between different disciplines and between various care agencies and families.

Until recently the well publicised Liverpool Care Pathway for the terminal phase of life used to be the sheet anchor of clinical, social and spiritual management. Sadly it is now being phased out and is supposed to be replaced by ‘individual care plans’ for such people. And as one can imagine, that has not happened. So, as in many such scenario, established plans have been dropped without another one in its place.

Care of the dying is not easy. And exactly like other forms of ‘curative’ care, it also warrants careful training, planning and organisation for its delivery.

The areas where improvements are urgently needed are a) recognition of impending death b) effective symptom control especially that of pain c) better communication with the relatives, carers and the statutory agencies d) improved out-of-hours services d) more useful care planning.

As mentioned in the beginning, death should be accepted as a ‘caring’ area exactly the same way where ‘cure’ is the objective. Changes in professional attitude and better training in the field is fundamental to any civilised and humane society. This should be encouraged by the authorities at all time and many such changes can happen without a need for any extra financial resources.