‘Put life into their days, and not days into their life’

Palliative care rejects the notion that people (patients) are just bodies affected by diseases that need treatment. Instead, the philosophy behind the practice of palliative care is recognising that people are human beings first, with a mind, body, spirit and emotions. These attributes are what make us who we are, and diseases ‘attack’ these fundamentals, resulting in both physical and psychological pain or distress. When patients lose control of their ‘being’, they tend to worry or become sad and angry, while fearing for their future existence. As a result of this, practitioners in palliative care also focus their care on relieving suffering to improve patients' quality of life.

While teaching in Nairobi, I came across this saying: ‘Put life into their days, and not days into their life’. Since then, I have wanted to look closely at its meaning. Numerous explanations of this quote can be deduced in relation to palliative care and its goals. For example, it highlights the need to ensure that patients' subjective quality of life is enhanced. At the core of this is the principle that life should not be lengthened or shortened (World Health Organization (WHO), 2012), but rather, every effort be made to improve the quality of life, so that the remaining months, weeks, days or hours can be comfortable. By extension, enhancing quality of life rejects the needless prolongation of life through futile attempts at treatment. Since true palliative care is about perceiving people as human beings and not a disease, all health professionals should seek to address the issues that concern their patients, and not just their condition. However, even the best palliative care cannot address all patient concerns, especially when patients feel like they have lost their integrity and that it is no longer worth staying alive. Obviously, this is a sensitive topic, as it prompts debate about assisted dying, which is not yet legalised in the UK and many other Western countries. It can be argued that those who seek assisted dying or even euthanasia subscribe to the ideals of the quote above. They no longer believe that putting days (quantity) into their life is of value, as the quality of life during these added days is poor. In a way, we could argue that we should always ensure that patients continue to live and not exist, and this is captured succinctly through the words of Dame Cicely Saunders: ‘You matter because you are. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but also to live until you die’ (Hospicare, 2016).