The hospitalisation of death: should more people die at home?

With the increase in the proportion of hospital deaths there is increasing debate about appropriateness of place of death. Death should be a family affair but is increasingly hidden from public view. In contrast to those who die at home, most of those who die in hospital die alone with no relatives or friends with them. Husbands and wives are less likely to have the opportunity to say 'goodbye' to their dying spouses. As people become less familiar with death they may increasingly assume that the terminally ill are better cared for in hospital. However, this need not be the case. Most people want to die at home, most do not for social rather than medical reasons. It is not the illness itself which leads to hospital admission in many cases but its duration and nature--and the type of burden it places on relatives. Although home care should be encouraged where possible, no amount of exhortation to the family or to the dying person of the advantages of home care can disguise the fact that demand for domiciliary services is greater than is now being provided. The paper is based on one read to a London Medical Group Symposium.