21 Jan

Medicalisation versus Quality of Life in Our Dying Days

Posted By Politybooks

Recent media reports have suggested that for those of us who spend the latter part of our lives in care homes, there may be issues with adequate treatment and care in relation to our basic needs such as hydration. BBC news has previously reported about risks of dehydration, and more recently, research has illustrated that elderly care home residents admitted to hospital are more likely to die as a result of dehydration when compared to those who live in their own homes. What does this mean for quality of life for those individuals?

Contemporary Health Studies aims to engage readers with debates about health in its broadest context, in which quality of life is, of course, a key indicator – good quality of life is indeed linked to better health outcomes. Chapter 1 highlights the importance of quality of life in how we define and understand our health, and this concept is also linked to wellbeing which is now increasingly discussed within policy circles. Since the publication of the health studies book, the field of social policy covered in Chapter 11 has moved on significantly. David Cameron has outlined a pledge to make happiness the new GDP (gross domestic product, which is traditionally used to measure economic success). Thus, happiness is now being explored as an economic phenomenon, and life satisfaction increasingly measured within countries. Despite this focus and the UK Prime Minister’s pledge, there are still gaps between rhetoric and reality as illustrated in the recent reports related to older people in residential care. For some, however, this is just the tip of the iceberg.

A recent book written by Atul Gawande (2013), called Being Mortal, explores some of the issues outlined above in much greater scope. As a medic, Gawande critiques our entire (Westernised and Americanised) approach to death and dying, suggesting that medicalisation of the end of life actually negatively affects quality of life in our dying days. He is also critical of the residential care model as it is generally delivered today for its limitations in relation to quality of life and importantly what matters most to people. Sociologists, too, have long been critical of many of the facets of medicalisation (see Chapter 4); thus many of these arguments are not new. However, the perspective of a medical insider critiquing current practices adds further weight to the existing debate. Gawande delivered last year’s Reith Lectures, in which his third lecture, ‘The Problem of Hubris’, examined the great unfixable problems in life and healthcare – ageing and death. Gawande essentially suggested that the reluctance of both society and medicine to recognise the limits of what professionals can do is producing widespread suffering.

These issues are not new. Policy debates rumble on, with the UK Department of Health starting a review in 2014 examining choice in end-of-life care, and medical research exploring ways to improve quality of life via new treatments and drug regimes. However, is it a medical model approach that we need to manage our ageing and our last days? Or should we be exploring more socially based models of care and support in order to improve our final quality of life? The ethos of Contemporary Health Studies is its focus on the wider determinants of health and the social factors that are important in relation to health outcomes. So should we now be considering what determines quality of life in our final days from a social point of view, rather than further medicalising the process of dying? As Gawande (2014) suggests, there are no perfect or easy solutions to this issue – however, there is opportunity for improving quality of life both as we age and die. This begins with recognising the current problems that exist within our medicalised approach to the management of these areas.

Gawande, A. (2014) Being Mortal: Medicine and What Matters in the End. Metropolitan Books.

Louise Warwick-Booth