Narrative medicine skills for end of life care

This paper looks at the potential of applying the skills of narrative medicine to end-of-life and palliative care as a means of enabling its spiritual and existential dimensions often overlooked in clinical practice. It tells the story of a family navigating the complex problem of managing the ending of a beloved mother’s life. It reflects on how the World Medical Association’s 2022 list of essential elements of care may be enacted. Amidst the dominant daily physical regime of medication and physical care, it captures the rare, unscripted moments of meaning and purpose of a lived life. It shows why these were the moments that ought to have dominated. But there were no learned skills to match those of clinical care, no script for professional or personal carers to elicit more of those moments. Both the presence of those unscripted moments and the absence of skill to elicit more speak to what the Lancet Commissioners declared in 2022 as the need for Western cultures to recognise the value of death by restoring the “spiritual or relational” to the process. Re-learning the language and concepts – that lost cultural literacy - is, this paper argues, essential to enabling a much improved ending of life. The field of Narrative Medicine offers a conceptual and practical framework for such learning by clinicians and non-clinicians alike.