We need to talk about death

Introduction: All healthcare professionals are expected to have an understanding of physiology across the continuum of life (The Physiological Society, 2020) –but does this expectation extend to the mechanisms underlying death? Death is a universal physiological process irreversible from the moment of initiation and with associated characteristic clinical signs and observations, such as the death rattle, reduced level of consciousness and Cheyne-Stokes respiration. However, the physiology underlying these such signs and death itself is seemingly largely poorly understood across healthcare disciplines (Miguel, 2020) and it was proposed that this is a consequence of an absence of such teaching across medical, nursing and allied health professional education programmes and accompanying resources.
Methods: To determine the extent to which the physiology of death is explored in healthcare education, 150 textbooks within the University of Aberdeen Medical Library catalogue and 30 documents detailing the recommended curricula for various healthcare programmes were reviewed for content related to death and dying. The textbooks were reviewed by examining the index pages for selected terms representative of the breadth of the phenomenon of death, such as “apoptosis”, “brainstem death” and “palliative”. The occurrence of the same terms and surrounding contextual information was recorded for each the syllabus recommendation publications examined.
Results: Across the breadth of the textbooks examined, the most frequently occurring selected terms were those describing processes of death at the cellular level. The most prevalent term was “necrosis”, paginated on 225 occasions, whereas only 6 references were made to “dying” and 7 to “brainstem death”. Terms relating to a more holistic, person-centred and care-focused perspective of death, such as “palliative” and “end of life”, arising on 480 and 404 occasions respectively, were most prevalent in the curriculum guidance documents studied. However, there was consistently an absence of content directly related to human death in the physiological sense .
Conclusion: Discussion about death, in the educational, healthcare and day-to-day setting, is necessary and relevant to all (Sallnowet al., 2022) but the physiology of death is not included in healthcare education programmes and resources. This may lead to inadequate understanding and recognition of the process of death, potentially to the detriment of the standard of care of the dying, the dead and the bereaved. It is proposed that this subject ought to be included throughout all healthcare curricula, with due consideration to the differing circumstances surrounding death, the breadth of educational requirements of all learners and the highly sensitive nature of the subject matter. Suggestions are made as to how to discuss death in an educational context, with the hope that these will provide a framework on which to develop and integrate this vital teaching.