{'fraction_non_alphanumeric': 0.023913909924272617, 'fraction_numerical': 0.018333997608609008, 'mean_word_length': 4.589086859688196, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Terminal illness - the right to choose.

There are going to be some significant changes with Gerodontology over the next few months which should help all those submitting manuscripts to the journal. Part of this involves the move to ‘Manuscript Central’, a web-based submission and peerreview system starting at the beginning of October 2008 (please see the separate article giving details) and as from the first issue of 2009, the size of each will increase by 25% allowing publication of more papers per issue. There are also other plans in the pipeline to enhance the profile of the journal and to increase its availability to readers. However, to return to more serious matters; there has been significant discussion within the media and in medical circles regarding the right of patients to choose how they deal with their terminal illness. There are enormous ethical and moral issues associated with this situation and almost everyone has a view which may or may not be influenced by personal experience, family and relatives, close friends or associates and their own moral code or religious belief. Perhaps, we should start with a definition of ‘terminal illness’ from Wikipedia. They state that it is used ‘to describe an active and malignant disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient’ usually within a period of 6 months. Glare et al. (BMJ 2003; 327: 195–198) reported that in their review of doctor’s survival predications in this group of terminally ill patients, patients were given survival times that tended to overestimate their life expectancy. Patients also approach the news that they are terminally ill in different ways. Some refuse all conventional medical treatment to avoid potential unnecessary side effects and try and live their life to the full in the time they have left, others take on any new development in the hope of success, no matter how slim and there is a further group that put their faith in more unconventional and possibly unproven procedures. However, Fried et al. (J Am Ger Soc 2007; 55: 1007–1014) found that there were inconsistencies in the preferences of older adults for the treatment of terminal illnesses over time. The Department of Health in the UK has put together with key parties, a 10-year ‘End of Life Care Strategy’ to give patients a choice as to where they want to die. The £286m up to 2010/2011 will help develop new services and the provision of high-quality palliative care as well as allowing people to choose to die in their own home if that is their wish; a strategy which many consider is long overdue. The evidence would suggest that this choice is not being met as up to 74% would wish to be at home to die but in fact only 18% can do so. If one reviews the places where people die, the majority die in hospital (58%) followed by residential and nursing homes (17%), hospices (4%) and the remainder elsewhere. Only 4% want to die in a hospital bed. There are also major regional variations with more dying in hospital in London than anywhere else in the country, and the highest percentage dying at home being in the north-west of England. A study by Amir et al. (Cancer Strategy 2000; 2: 55–60) found that men were more likely to die at home or in hospital but for women it was nursing homes and hospices. If patients lived with a partner there was a greater chance they would die at home. They conclude that there should be a move to providing care plans which more closely reflects patients’ wishes. If a comparison of deaths in hospital is made with those in other countries, in Sweden it is 62.5%, the USA 49.2% and the Netherlands 34%. Unfortunately, one of the reasons that the numbers are so high is families state that there is a lack of outside support and means of pain management for their relatives. A paper by Munday et al. in the J R Soc Med (2007; 100: 211–215) reports that although people in modern society have an enormous amount of choice regarding their health, education, career, holidays and material purchases, issues relating to the time, manner and place of their death were virtually beyond them. They point out that there have been moves to legalise euthanasia and doctorassisted suicide in some countries, but in fact it is used by relatively few people. An example is in the Netherlands where only about 4% of deaths are reported to occur this way. It will be interesting to note what will happen in France where the Senate has passed a bill allowing doctors to stop providing medical assistance where it ‘has no effect other than maintaining life artificially’. The researchers also discuss the effects on healthcare professionals with concerns of how the patients might react to such discussions, their personal fears dealing with such an emotive issue and apprehension regarding care plans which they may be unable to fulfil. It is important that when recording a patient’s potential preferences for controlling their own death, it must