Paradoxes of death and dying

A week in the month of May each year is dedicated to encourage, cajole, inspire and convince society to talk openly about death and dying matters.This week, appropriately termed ‘Dying Matters Awareness Week’ was born out of the Dying Matters Alliance's attempt to create a broad-based, inclusive national coalition with the sole aim of changing public perception, knowledge and attitudes towards dying, death and bereavement (www.dyingmatters.org). This year's week (13–19 May) has the theme ‘Are we ready?’ and will showcase various creative activities across the country that will encourage people to talk and think about dying.The goal is to make dying easier for all concerned. However, there are certain ironies and paradoxes to consider before this can be achieved.

Caring for dying patients presents a range of challenges, from symptom control and management and effective communication to managing the patient's psychological concerns, which may make community nurses feel inadequately prepared to support dying patients. The irony, though, is that dying is the only certainty, and yet it is a beautiful mess that presents so many challenges for both patients and health professionals. For example, dying has increasingly become part of social death, in that how patients die does not only consider the patients wishes but the sum of their social relations. Some patients leave instructions behind (e.g. through wills) in order to share or bequeath their estate after their death although, by the same token, they remain part of the living. It is acceptable that such wishes are carried out and may even be enforced through a court of law. The paradox is that, although the dead may no longer be physically with us, they are in fact still present among us.