In 2008, vets at Blair Drummond safari park recorded an unusual occurrence. As one of a small group of chimpanzees lay dying, others tended to her. We have since learned that elephants can show similar behaviours but, amongst non-human animals in general, it is relatively rare to find evidence of care, interest or support for the dying. The typical response to terminal decline is neglect, disinterest and abandonment.
But we, homo sapiens, humankind, may be different. We seem to possess an innate desire to care for our dying, created by the unique combination of our sentient ability to recognise that life is finite, what death therefore signifies, and our capacity for empathy.
Over the known history of human dying, we have instinctively felt the need to be present with our own as they die. We share goodbyes. We tell each other of our love. We forgive and ask for forgiveness. We give and receive words of thanks. Sometimes words never said before, provoked by the extremity and intimacy of the moment, or sometimes well known, repeated, and remembered. Sometimes words are not necessary. The holding of a hand, the stroking of a brow. A kiss.
Nurses, care home assistants, and doctors bear witness to the importance of these acts. Family members will travel far, spend nights by the bedside, and ensure that someone will be there at the end. And these same professionals also bear witness to the guilt, anxiety and heightened grief that can occur if the opportunity is missed.
COVID-19 brings death to many. In hospitals, care homes, and our own houses. But dying from COVID-19 is somewhat different. Those in contact with the dying person might contract the infection, or pass it on to others, within or outside the place of care. But these risks can be reduced. With personal protective equipment, social distancing, and isolation, family members can balance risk to themselves and others just as the caring professions do.
In many human disasters where large loss of life occurs - the battlefield, a plane crash, a tsunami - it is impossible to be present. We struggle with the consequent emotions but find some solace in the fact that we had no choice.
But with COVID-19 we do have a choice. Decisions regarding the presence of family at the bed side of their dying are not simply matters of infection control. And we should not permit them to be such. They are matters of our humanity. Matters that define who we are, our understanding of what life is, and how our lives must all end. We must consider these feelings as much as we consider the risks.
Maya Angelou, the American activist and poet put it thus - "….people will forget what you said, people will forget what you did, but people will never forget how you made them feel."
We know how we will make people feel if we unnecessarily prevent them from being with a loved one at the time of their death. We do not need to make them feel that way. We can find ways to allow families to be together at this time. The Scottish Academy has published guidance this week to help us achieve this. If we have indeed risen above other species, now is the time to demonstrate our compassion, our dignity, and our true capacity to care.
Professor Andrew Elder is President of the Royal College of Physicians of Edinburgh, a consultant geriatrician in NHS Fife, Honorary Professor at Edinburgh Medical School and Presence Scholar at Stanford Medicine, California, USA.
