Patient dying in hospital: an honoured guest in an honoured place?

Abstract

This title is adapted from an inspiring essay by Ken Warpole.1 Commissioned by the Irish Hospice Foundation in 2005, Warpole reviewed the architecture and design of hospital spaces in which the dying find themselves. The idea of hospital being an honoured place with dying patients as honoured guests opens a new window into our daily reality of working in hospitals. In 1908 William Osler undertook a substantial study of sequential hospital death in the USA.2 Having studied 486 deaths at John Hopkins Hospital, Osler summarized his findings with the reassuring statement ‘90 suffered bodily pain or distress, 11 showed mental apprehension. The great majority gave no sign one way or the other like their birth their death was a sleep and a forgetting’. Much of the literature and research concerning the modern attitude to death contains a critique of hospitalized death with its representation as a threat to an idealized good death.3,4 Literature suggests that the battle lines have been drawn between relatives advocating for the person who is dying and hospital staff who ‘manage’ the care of the patient who is dying and provide the ‘archetypal bad’ medicalized death.4 Medicalized dying is described as divorced from lay understanding, culturally and religiously barren.4 In many countries, the majority of people die in hospital and will continue to do so.5 The number of home deaths in England and Wales could reduce by 42% by 2030.6 Seventy-five percent of patients with cancer died in institutional settings.5 Sixty percent of deaths occurred in hospital in USA.7 With a projected dramatic rise in total number of deaths due to increasing ageing of the population, death at home may only be a reality for 10% of patients.6 While it is the case that …