Society has practically shut death out, almost denying that it exists. Rather than acknowledge the existence of death, too many try to hide it. It is as if we are trying to convince ourselves that ‘out of sight, out of mind’ works even when it comes to the inevitable end of life.

This leaves both the dying person and the family or friends unprepared. The culture of dying needs to be rethought by focusing on the provision of an end-of-life care that gives dignity to all.

In 2014, in the first-ever global resolution on palliative care, the World Health Organisation called upon WHO member states to improve access to palliative care as a core component of health systems, emphasising primary healthcare and community and home-based care.

For too long, national health policies and systems in Malta have not included palliative care at all. The dying often have no option but to be institutionalised in a hospital. This is about to change.

Health Minister Chris Fearne has launched a consultative document focused on palliative care at home and in the community. He argued that “the best way to die is in a familiar environment”. Yet, statistics show that only 12 per cent of deaths in Malta and Gozo occur in private residences. The need for palliative care in the home will continue to grow due to the ageing population and the increasing burden of terminal illnesses. So the direction taken by the palliative care strategy is more than welcome.

The consultative document makes several recommendations that follow the WHO 2014 guidelines. Implementing these recommendations will be challenging – addressing suffering involves taking care of issues beyond physical symptoms. Multidisciplinary professionals involved in end-of-life care must address practical needs to support patients and their caregivers and provide bereavement counselling to family members.

International medical research indicates that patients needing palliative care include mainly those suffering from cardiovascular diseases, cancer and respiratory disease. Pain is often one of the most frequent serious symptoms experienced by these patients needing palliative care.

The WHO believes that one of the obstacles to adequate palliative care in the home is the need to support the access to opioid pain relief. To ease their suffering, palliative care medicines, including pain relief, would need to be readily available for those in end-of-life care, including children.

Effective palliative care is recognised under the human right to health and is best provided through person-centred and integrated health services. All those involved in caring for the terminally ill in the community need to pay special attention to the specific needs and preferences of the individual under care.

Analise Borg, a public health consultant, is correct in arguing that we need to address the stigma surrounding palliative care and the fear of having a relative die at home. Since reshaping the culture of dying will be a tough challenge, a sharp focus on palliative care training for health professionals is crucial.

The WHO advises member states to have “policies for strengthening and expanding human resources, including training of existing professionals, embedding palliative care into the core curricula of all new health professionals, as well as educating volunteers and the public”.

The health authorities must involve and continue to support those non-profit organisations which are already giving invaluable support to terminally ill patients and their families, foremost among them Hospice Malta.

Involving the whole spectrum of people who help manage and engage families and caregivers would help build a system of home care for the terminally ill that reflects what all of us would want as we come to the end of our lives.