Contemporary dying presents a series of questions for the dying person, their family and the professionals who attend them. These questions are embedded in complex ethical debates which have legal, medical, ideological, philosophical and religious ramifications. This situation arises from two features of modern life – the fact that medical advances allow us to control, to a great extent, both the manner and moment of death, and a concern for human rights, which constantly seeks to balance the rights of the individual with the wider interests of society. Woven through are a number of subsidiary issues which pose their own sets of questions. When is a person effectively dead? How do we determine capacity and incapacity and who should take ‘life and death’ decisions on behalf of a person deemed incapable of making their own? How do we determine quality of life? Are some lives more valuable than others when it comes to allocating resources or making treatment choices? Do a person’s wishes and choices voiced at one point in time have currency when the situation changes? These and many more questions about the relationship between life and death face individuals and families in their personal lives and professionals in their daily work. All too frequently individuals find themselves surprisingly ill-prepared when confronted with a particular dilemma, despite increasing public debate, fuelled by some high-profile cases.
The ongoing demographic changes discussed in Chapter One have resulted in many of these issues seeming to crystallise in the care of older people. These are separately discussed in Chapter Six.
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