Dr Simon Edgecombe, a Speciality Doctor in Palliative Medicine at St John's Hospice, reflects on why we should all be more open to talking about end of life care and death itself. 

As people write the last chapter of their lives, the professionals around them need compassion and skill.

My work at St John’s Hospice gives me the privilege of being alongside people at this crucial time. The day I lose that sense of privilege I should probably leave.

Benjamin Franklin pointed out that nothing is certain in life other than death and taxes, but in our society death remains largely taboo. It knows no boundaries of culture, creed or class.

Inevitability and taboo, then, are mixed in a recipe, along with fear and a media culture that portrays death in clichés.

Given a medical establishment that has historically looked on death as failure it is no surprise that so many arrive at that last chapter with thoughts, ideas and feelings held in private.

Individuals and the loved ones around them deal with approaching death in different ways. I’ve witnessed people trying to protect each other in an agony of silence and important words left unspoken.

These are difficult times and avoidance can be an instinctive way of coping. Wills are left unwritten and wishes not discussed. “I don’t know what he wanted,” sounds painfully hollow later, and actually, of course, not getting matters in order burdens rather than protects those left behind.

In contrast, I have watched people have conversations that matter to them, reconcile old conflicts, share plans about their place of care, pack boxes with the stuff of memories for those they are leaving behind, seek spiritual peace and even plan their funerals. I have seen aged couples work out that he needs to learn to cook, or she to drive and look at one another and say “I’ll be alright”. And mean it.

One of the key decisions for palliative patients to make is where they want to be cared for and die. These are often complex decisions that are best made with the most open discussion possible and with the advice and guidance of the team of professionals involved.

Shirley Mørch described bravely and eloquently in this newspaper how that whole team supported her and her children through the death of her husband Chris at home. This enabled as normal a family life as possible through his last illness (The Westmorland Gazette, September 1). Many only come to realise that being cared for at home is an option when honest conversations have taken place and the scale of the help available is understood.

For others care at home will not be the right choice. This may be the result of practicalities, personal preference or the need for the more intensive care that is best provided somewhere like St John’s.

There is no 'right' answer, only the best choice possible for that person and those around them at that time.

Flexibility is often needed. Talking about these matters in principle is often easier in advance before the calm of health gives way to the turbulence of illness.

Grief cannot be dodged any more than death, but the consolation of being able to look back and know that wishes were met can be priceless. Palliative care’s mantra is 'one chance to get it right'. There’s no rehearsal.

The Westmorland Gazette’s Hospice Angels campaign is a fantastic opportunity to give more choice to the people of the South Lakes at the end of life. It’s up to us all to challenge taboo and engage in talking about those choices.

So put the kettle on, reach for the remote and turn off the TV. There is no right time to start talking.

But there is no better time than now.