Winter Lecture Series: A reflection on choice and its limits for those dying in very old age

by Richard Meade
Head of Policy & Public Affairs, Scotland

Professor Walter speaking at the Winter Lecture Series
Professor Walter speaking at the Winter Lecture Series this week

This week Marie Curie, along with our partners the Scottish Partnership for Palliative Care, hosted the last evening of our Winter Lecture Series. Professor Tony Walter, a professor of death studies at the University of Bath spoke on the subject of 'Living and dying in very old age: the limits of choice'.

Professor Walter stated that one of the great achievements of advanced industrial societies is that most people now live to a good age. However, with that, many more people are now living and dying with multiple long-term and terminal conditions, such as dementia. He suggested that only a few generations ago society feared cancer or the ‘Big C’, but now, as we live to late old age, the kind of dying many people fear is around conditions like dementia.

He discussed the care that people can receive at the end of life and particularly palliative care. He challenged whether this care, developed in response to cancer, can be effectively rolled out to other conditions, such as dementia. He noted that the principles of palliative care, such as informed choice and care within the family were developed for mid-age cancer patients. However, this may not work for very old people who may have no clear prognosis, suffer multiple conditions, including cognitive impairment, and lack a physically able resident family member or carer.

Professor Walter considered communitarian and relational approaches to wellbeing, used in places such as the Far East and Africa. He believes these may provide a better basis for care than standard Western principles of choice and autonomy. We should consider these approaches if we are to provide older people with the care they desire and deserve at the end of life.

This talk concluded our Winter Lecture Series which has seen over 200 people attend the three events. With over 95% of respondents stating that the events were either very good or good, the series has clearly provided a useful contribution to ongoing thought and discussion into the future of end of life care in Scotland.