#BTEditorial – Time to embrace dignified end-of-life care for all Barbadians

For better or worse, for the rich and the poor, our public general hospital, the Queen Elizabeth Hospital, has been a beacon of hope and healing for countless residents and visitors since 1964. Yet, as we progress into the 21st century, it is past time to reconsider the way we approach end-of-life care in Barbados. Our nation deserves more than simply overcrowded beds and long wait times for acute care. We believe the solution lies in compassionate, dignified, and holistic hospice care and a change in attitudes towards death and dying.

Hospice care transcends the limitations of our overburdened hospital. It is a paradigm shift from the traditional, often stressful hospitalisation process for those nearing the end of their journey, where the best medical judgement is that healing is no longer a viable option. Our hospital, for all its warts and flaws, is an invaluable institution. It demands a greater respect for the demands placed on its resources and pressures on its staff to manage end-of-life care that could be alleviated with a more specialised approach.

The need for hospice care in Barbados is not solely a matter of medical necessity; it is a moral imperative. It speaks to the core values of compassion, dignity, and equality that we, as Barbadians, say we hold dear. Dying with dignity should not be an exclusive privilege for the wealthy and well-connected. It is a right that every citizen should have access to, regardless of their socioeconomic status.

Hospice care offers an environment where patients and their families can focus on quality of life in the final stages of a loved one’s journey. It provides expert pain management, emotional support, and a tranquil setting that fosters peace, acceptance, and closure. The strain placed on the general hospital due to the heavy demand on its beds for care for those suffering from end-stage disease is a situation that can no longer be ignored. The acute care role of our general hospital, vital for emergencies, critical medical conditions and maternity care is being compromised by the overwhelming need for beds that could be better accommodated by hospice care.

Changing our attitude towards end-of-life care is not a sign of disregard for human life but a testament to our progress as a society. It reflects our collective understanding that a humane and compassionate approach to the end of life is a sign of a mature and caring society. Hospice care is not about giving up; it’s about embracing the time that remains with grace and love.

As the administration seeks to move the St Michael District Hospital, the legacy of the colonial almshouse, to a new complex at Waterford, perhaps it should consider the provision of hospice care services that are accessible and affordable for all. It can also create an enabling environment for the development of quasi-public and private hospice facilities, so that every Barbadian, regardless of their background, can receive the care they deserve in their final days.

There is a rich untapped resource in the many returning nationals who were trained in Britain’s National Health Service as nurses. UK medicine has long been more realistic about, and sensitive to, issues of the viability and quality of life, in sharp contrast to the technologically and financially intensive tradition of maintaining life that has been a feature of American medicine.

No, this is not about pulling the plug on Granny and Grandad. It is about really sanctifying their value in our lives and respecting the quality of their lives to the very end.

Hospice care is not a replacement for a general hospital but a complementary and specialised service that can take the burden of end-of-life care off the shoulders of the hospital. By transferring the responsibility for end-of-life care to hospices, we can ensure that our general hospital can focus on its primary role of providing essential acute care services without the constant challenge of overcrowded beds.

But it’s not just about a building but about people. In pursuing a more compassionate and dignified approach to end-of-life care, we need to engage in a more mature and open conversation about death and dying. Just as we celebrate the arrival of new life with midwives, we should consider the employment of death doulas in our ageing population.

A death doula serves as a supportive guide through a profound transition in life. Their role is to provide emotional, spiritual, and practical support to individuals and their families during the end-of-life process. They help individuals articulate their final wishes, navigate the complexities of medical decisions, and find solace and meaning in their final moments.

By embracing the concept of death doulas, we can encourage a more holistic and person-centred approach to end-of-life care. They play a crucial role in ensuring that a person’s final moments are as comfortable, dignified, and in alignment with their values as possible.

There simply needs to be a mature conversation about death and dying that can help us dispel the fear and stigma often associated with something that comes to us all and should not be taboo. By openly discussing end-of-life preferences, we can empower individuals to make informed choices, thus reducing the burden on families and healthcare providers to guess what their loved ones might have wanted.

The modern history of Barbados has been of people taking progressive and compassionate steps that align with values of fairness and decency as a colony emerged from deprivation and abject misery to an independent nation, exultant and free. But as the journeys of these history-makers reach their inevitable end, part of this nation’s next chapter should be about an investment in a more empathetic and thoughtful approach to life’s end while strengthening the healthcare system that brings new life and saves lives from an untimely end from disease or trauma.