Mother and child, Tokyo

One of the important holisms we discussed in Japan, because my colleague Dr Debra Swann focused on it, is what it means to be providing palliative care in a general hospital. There are pluses and minuses of course, but one of the striking things, talking to a hospital social worker recently, is the anxiety of some acute medicine colleagues not to want to recognise when someone is dying because of their commitment to doing all they can to provide treatment.  Of course, we see this in hospices, in the patient who arrives at the last moment, or who has not really had the chance in hospital or out-patient treatment to work through what their increasingly advanced illness means for their survival and their family.

All the fuss about assisted dying has not helped this; some doctors are beginning to fear that getting people to think about death means that they are going to be accused of trying to kill them. The assisted dying lobby has not yet got the point that most people want the very opposite of assisted dying; they want all possible forms of assistance to live.