Horizon

This programme contains some scenes which some viewers may find upsetting from the start.

So, this is John, and, er...

Where's the...the clapperboard?

Camera, action! Action!

And Avril is his daughter.

And you were in real trouble in the care home

you were staying in, weren't you?

I certainly was.

Talk to me about how you were feeling

in the time leading up to coming in here.

Well, I was absolutely...

..full of fear

at the prospect of living for several years.

And I was getting more and more depressed. Yes.

Because there didn't seem to be any light at the end of the tunnel,

until a certain person came along

and offered me an alternative,

which I grabbed with both hands.

So, the alternative for you then, I guess, was,

"Do I see, if I stop the oxygen, does that mean

"I'm just going to die from the lung disease?"

Was that what was in your mind at the time? Yes.

I was being very envious...

..of people...

..who were dying

and were leaving it all behind.

Do you feel that the way in which we've used the medicines

to help you sleep, do you think that's been effective?

It's been very effective.

How do you think things have been in the last couple of days?

Absolutely wonderful.

I have now become...

..a happier person,

because I've been getting what you would call real sleep.

Sleep which has, today, enabled me to have a meal,

which I haven't had in a long time, and really enjoying it.

Mm. One of my favourites - chips.

Egg and chips. Egg and chips, with vinegar.

Wonderful.

The fact that I shall be able to...die

..not feeling pain...

..I find it very...very helpful.

So, you know that it's really about you letting go of life?

Do you understand that one? Yes. Yes.

So, there is something about preparing and then letting go,

and then you go, rather than me doing something to make it happen.

You understand that difference? Yes.

Thank God for you.

I don't have any fear of death now.

The only thing I fear now is life.

The only thing I'm looking forward to is...

..dying a...a happy death. OK.

That's what I've been praying for, is a happy death.

I feel gutted now that I won't be able to see this!

AVRIL LAUGHS

Yeah.

John had a good Christmas,

and then he slipped off, um...over about an 18-hour period.

Largely, um...asleep or unconscious.

So, it was a good letting go.

And for his daughters, I think, very meaningful.

It allowed the whole family to get to the same place at the same time,

in terms of, "This is the end, and it's fine".

However much we don't like to think about it,

dying is something all of us will one day have to face.

I'm a doctor, and I specialised in anaesthesia

and intensive care medicine.

And in this programme,

I want to take a closer look at the ways we die.

Despite everything that medicine can do,

our lives don't always end the way we want them to.

And even though only around 3% of us say we'd like to die in hospital,

research suggests that more than half of us will.

Death is a certainty, but until recently,

medicine invested precious little effort

in making sure that we got it right.

And the vast majority of deaths aren't sudden or unexpected,

and so there should be time.

Time to prepare, time to make sure that we have a choice

over how and where it happens.

I've spent three months getting to know two institutions

specialising in end-of-life care.

I know I'm on a short wicket.

I have worried about it, but then I say to myself, "What's the point?"

On the way, I've met some inspirational people.

I want to go out saying, "She was naughty to the end".

I've had some of my long-held beliefs challenged.

I'm confident now that I will get there. Yeah.

And I've been looking for answers to some of the most difficult

questions we'll ever have to face.

Nearly everyone feels better afterwards

for having had these frank conversations.

When is the right time to stop aggressive medical treatments?

I believe it's morally wrong to waste a dying person's time.

And one of the easiest ways of wasting a dying person's time

is to offer them treatments which you know jolly well

are going to make very little difference.

What are the alternatives to dying in hospital?

I want to be at home when I die.

Does a better death always have to mean a shorter life?

There's quite a lot of evidence that in some circumstances,

palliative care even improves people's quantity of life.

And what offers the best quality of life...

..as we face death?

Making this film, I made repeated visits to St Christopher's Hospice

in South London.

Here, I met people in the last days of their lives,

along with the clinicians who continued to care for them.

My name's Rob George, and I'm medical director

at St Christopher's Hospice in London.

It's very easy in this day and age to think that dying

is all about the medicine and all about the treatments,

when, in fact, it's not.

Managing pain, managing symptoms are not that difficult.

It's really the person leaving the life

that is...the problem in hand.

St Christopher's Hospice is a registered charity

partly funded by the NHS.

Hi, guys.

Here, I met with people who are facing death... Hello, there!

Hello! Hello, Barbara. Hi. How are you?

..like Barbara Elton.

She has advanced cancer and needs help dealing with the symptoms.

The first thing any of us want, I think, is the pain sorting.

That is the major priority.

"Please, please, please sort out my pain.

"If you can't get rid of it, I understand,

"but just sort it to the best you can.

"The best of your ability."

Which they did, and they did...

..really, really quickly.

Until in the end, I was becoming the sort of pest of the ward.

# Da-da-da-da-da. #

All singing, all dancing. THEY LAUGH

I was a total nightmare.

A pest of the ward.

I know you were really scared that hospices

were about being tucked up in bed... Going in and never going out.

Never going out. A one-way street.

But the interesting thing is, you're planning to go home now, aren't you?

Yes. Because I haven't given up yet.

You've still got to face the prospect that you came in here and not ER...

..for a particular reason.

And that is the reason you are...

I shouldn't talk loudly, should I?

You can talk as loud as you like, love.

And that is the reason you are going to die. Mm.

Now, that has fundamentally changed everything in my life.

You're in a ward with... You're not on your own.

No, no, no, no. There are people here.

So, people around you here might themselves be dying.

Has that been a problem for you?

No. It's just...

..the natural course of things now.

It might be me next, tonight.

It could be me, it could be...

I hope not, because you get favourites, don't you?

It could be Margaret, it could...it could be any of us,

but we expect...expect to go.

Has this always been your attitude to death and dying?

I've never given it any thought before.

Now that you're here... Facing it. Yeah.

One way or the other. Where are you in your thinking about it now?

What do I think about it?

Well, I certainly don't think, "When?"

I certainly don't think, "Why?"

Because that's obvious.

I has to be thought about.

Um... And why? I've got a dirty great lump there which explains.

But I still...

Come here. Come here.

Come here, come here.

BARBARA SOBS UNCONTROLLABLY

It's fine. It's all right, it's all right.

It's all right. I still don't want to go.

Well, you're not going anywhere, apart from home with me.

Aren't you? For...for the short-term.

Yeah? I suppose so, yes.

Yeah? So, you're coming home, aren't you?

Yes, and I'm so embarrassed.

Please don't be embarrassed. Don't be silly.

You're all right.

The majority of deaths are relatively straightforward.

They're not sudden and dramatic and filled with horror.

It's about the biography, not the biology.

By and large, once people have engaged with it

and understand what's happening, it's an easy process.

But it's only an easy process

if somebody has resolved, er...their relationships,

completed their tasks,

and are thinking about their preparations,

they're saying their goodbyes and their sorrys

and their thank yous,

and have decided what kind of meaning they want to attach

to the life they've led,

and whether there's anything beyond the grave.

In our acute hospitals and emergency wards,

medicine is rightly focused on how best to try and treat disease

and cheat death.

Advances in medicine mean we're actually quite good at this.