Top five regrets of the dying

The UK’s Guardian has a story that claims to list the “Top five regrets of the dying“. The background is that Bronnie Ware, a palliative nurse based in Australia who counselled the dying in their last days, has revealed the most common regrets we have at the end of our lives. OK, I know you are curious, so here is a quick summary …

  1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.
  2. I wish I hadn’t worked so hard.
  3. I wish I’d had the courage to express my feelings.
  4. I wish I had stayed in touch with my friends.
  5. I wish that I had let myself be happier.

Its an interesting list to ponder over, and I’ll come back to it later, but first a key point, this is not a definitive scientific list, it does not claim to be and of course it never could be. Instead it is just a list of her observations that she collected over several years working in palliative care with patients who were in the last few weeks of their lives.

OK, I confess, this list is just a segue to where I am really going. What exactly is palliative care? – It is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients, not just for the dying, but for all at any stage of an illness. Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease or cause. This can include treating nausea related to chemotherapy or something as simple as morphine to treat a broken leg or aching related to an influenza (flu) infection.

This entire area is in some ways I suspect a bit of a minefield for skeptics … why? Well because palliative care not only takes input from medicine as we understand it, but also seeks other inputs. I bet you can see  where I’m going with this … and yes you are right … Homeopathy.

They just love it … here we have a care regime that alleviates symptoms, but does not necessarily cure. As an aside, I’m making the assumption here that you do indeed appreciate that Homeopathy is complete bollocks, it contains zero active ingredients and dispenses nothing at all except the placebo effect. Yet now I find a bit of a quandary in all this in a palliative care context …

Lets assume Patient X has an illness for which there is no cure and it is in its last stages. Nothing can be done except pain relief:

  • Do we just stick with traditional medicine … anticonvulsants to treat pain, and morphine to treat dyspnea, etc…
  • Should we object to the deployment of Homeopathy?

Remember, there is no cure, what you are dispensing is additional comfort and hope, and yes it would just be the placebo effect of course. My instinct is to suggest that no, we should be true to the truth, and that we should not start pretending that it really works. If you start blurring the boundary like this, then where exactly do you draw the line?

Please do not think I am criticising palliative care, I’m not. But rather, I’m expressing the concern that it can open the door to woo and so result in ineffective palliative care. I do truly understand the temptation. One of the most frustrating aspects for patients with stage IV cancer, particularly solid tumors, is that there are no good curative therapies . Over the years, doctors have thrown everything but the kitchen sink at patients with stage IV disease, largely with disappointing results, but please, lets not give in to woo, but rather stick with the stuff that actually works.

One further thought – is aggressively pursuing a cure using every form of woo really the best goal? Success is possible but very unlikely; and the search can become obsessive; dominate the searcher’s life; and consume time, funds, and energy that might be best employed otherwise. (Yep, I’m back to thinking about that list and the regrets we might have) How about pursuing other goals that have a much higher chance of success: spending quality time with the loved one, trying to make the most of whatever time they has left, helping them to cope, trying to make their remaining life as worthwhile as possible. It is not a time to inflict false hope and even worse torment them with weird diets that will do nothing except make their last few weeks a misery, instead it is a time for saying goodbye, and creating good memories for the survivors.

Back to that list above – A Poll

I’m curious, can you relate to the observations made by the palliative nurse? I do wonder how many she cared for (how big was the data sample?), and I also need to ask myself how diverse the group was. I’m also slightly cynical about all this. The nurse initially recorded her observations in a blog called Inspiration and Chai, but it gathered so much attention that she put it all into a book called The Top Five Regrets of the Dying. (I don’t see any reviews … yet). Since she wants to sell a book, it is just possible that it might (or might not) be a tad biased, and so one further regret for some is that they bought the book.

So what if we cast a wider net, would the answers stay the same, or would we find more interesting answers? Lets see …

Looking at the list of 5 Regrets ...

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Finally, there are other possible “regrets” that could be added to that list … for example, “Not looking both ways when that bus was coming.

However, I’ll let Woody Allen have the last line … he is quoted as saying …

I don’t want to achieve immortality through my work… I want to achieve it through not dying.

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