Let’s talk about death and dying

‘Let’s talk about sex’ said Salt-N-Pepa over 30 years ago, on their blockbuster hit inviting us into a difficult conversation. While this might once have been considered a subject to avoid, it has surely been replaced by death and dying as the principal taboo subject in today’s society. Unless we talk about it, we cannot make plans for it or organise the care needed by both the dying person and the loved ones left behind. I am delighted to have secured the services of Kathryn Mannix as guest editor for this crucially important themed issue. Some of you will know her from her extraordinary books on the subject and/or her social media presence. She brings the gravitas of a life devoted to palliative care, moulded with compassion for all involved. Please read her guest editorial where she describes in detail the depth and breadth of the contributions that we have commissioned from experts in this field.

I would just like to highlight a couple of innovations in our format featured in this issue. For the first time in Future Healthcare Journal (FHJ), we present a video article featuring a nuanced discussion on the controversial and topical theme of voluntary assisted dying,¹ which is a ‘must-watch’. In addition, we feature an article written in collaboration with a graphic artist, which can be read either in graphic pictorial story style or in conjunction with the linked text for more background detail and references.² Do let me know what you think of these novel article formats.

Elsewhere, we feature our usual eclectic mix of stimulating articles crossing disciplinary boundaries. These include three papers relevant to recent issue themes together with articles on hospital informatics, planetary health education, transgender inclusionary healthcare, managing workplace stress and lessons in leadership.

Nicely complementing our commissioned papers, a group of authors from the Cicely Saunders Institute of Palliative Care in London³ present the results of a national survey of the understanding of and access to palliative and end-of-life care services. The results showed that, compared to White British people, people of Asian, Black, Caribbean or African ethnicity were less likely to be aware of palliative care; have correct knowledge of palliative care; or trust healthcare professionals to deliver it. Much work clearly remains to be done to achieve equity of access to these services in the UK. Picking up the theme of our December 2025 issue on symptom-based disorders, Chris Barker⁴ calls for a fundamental re-orientation of clinical thinking, service design and commissioning, arguing that the prevailing biomedical model fails to address the complexity and lived experience of patients with these disorders. He states that integrated care models involving MDTs and community-based support can improve outcomes, reduce hospital admissions and enhance quality of life. Yet the current political landscape is often of service fragmentation, short-term targets and inconsistent digital infrastructure, which conspire against improving outcomes for these patients. John Warner and Alisha Khan⁵ ask why there is no regulation despite evidence that ultra-processed foods are hazardous to long-term health. The answer refers back neatly to our themed issue of June 2025, guest edited by Chris van Tulleken, which highlighted the conflicts of interest surrounding public health policy and our collective failure to call out the commercial elephant in the political decision-making room. The authors advocate for a range of regulatory measures including immediate bans on additives of proven harm, advertising and marketing restrictions – especially on those targeting children, subsidising fresh food, and clearer food labelling to inform better dietary choices.

How often are you left frustrated by hospital information systems, having to wade through several different programmes to find the key data that you need to manage the patient sitting in front of you? Yet at the same time, you recognise that the vast amount of information on the system on similar patients could be harnessed to help inform and improve your clinical decisions. Bowyer et al⁶ show that aggregating health record data into a clinical intelligence tool called PICTURE, developed at Great Ormond Street Hospital, has the potential to inform and improve clinical practice and act as an informatics consult to address clinicians’ questions. Furthermore, they show that this is achievable for any typical healthcare system with an electronic patient record without the need for a large team of analysts. We will follow this development with interest.

Are you concerned about the impact of climate change on human health but feel you lack the knowledge, tools and resources to address the issue? If so, you are in the majority of healthcare professionals according to Prifti et al.⁷ Yet as healthcare professionals we possess significant social influence, play a key role in sustainable transitions, serve as critical barriers against pseudoscience and misinformation, can help address regional environmental health disparities, and contribute to lowering healthcare costs by promoting illness prevention. The authors argue that a curriculum about environmental and planetary health should be urgently included into medical education, continuous professional training programmes and multidisciplinary teams.

Avoidance of healthcare is widespread among trans individuals and is driven not only by anxiety, but also by real fears of discrimination. In 2024, the UK Supreme Court delivered a ruling that the words ‘woman’ and ‘sex’ refer strictly to biological definitions that have had significant impact for healthcare delivery. Single-sex spaces such as women’s shelters, changing rooms and hospital wards are now legally permitted to exclude trans women, provided that it is justifiable and proportionate. The Equality and Human Rights Commission have also submitted interim guidance, subsequently revoked, on how to deliver public services in accordance with the Equality Act, further adding to confusion. In an opinion piece, Simrit Braich⁸ writes a highly relevant, thought-provoking and nuanced reflection on how this may play out in practice and asks whether overall this will be a step backwards for transgender inclusivity in healthcare.

FHJ has published many articles on workplace stress in doctors, but few have focused on medical students. Lea et al⁹ ask why we wait for these problems to manifest in our professional lives when we know that stress, burnout and mental health problems are pervasive among medical students globally. They cite relevant data showing that burnout affects up to 50% of medical students, with around 30% experiencing depression and 10% suicidal ideation. Furthermore, medical students have worse mental health outcomes than qualified physicians and mental health problems manifesting at the undergraduate stage are more likely to persist throughout their careers. Instead, as in general prevention is better than cure, we should be proactively preparing students for the inevitable stress of working within healthcare, whether that comes from distressing patient encounters, understaffing, challenging professional relationships or training and exam worries. They argue that we should be supporting students to develop effective and healthy ways to handle stress, failure to do so being equivalent to sending soldiers into battle without armour. The authors have conducted pilot studies evaluating a tailored CBT approach in medical students which has demonstrated improvements in resilience, burnout and depression indicators, warranting further larger-scale studies which could be applicable across the globe.

Many of us will have experienced toxic leadership styles in our careers, so the opinion piece by Thomas Jackson¹⁰ on the centrality of values-based leadership, specifically that of service, is most welcome. As a former British army officer turned NHS doctor, he reflects on how the values taught by the military leadership of selfless commitment and leading by example and integrity are just as crucial in medicine. He argues that to deliver the best care, we must value and develop these leadership behaviours as early as possible in our careers. Serve to lead is the title of a book read by all inducted cadets. The value of service as leadership was once a core principle in medicine too, but this has perhaps faded in the face of modern pressures and challenges, although it remains as relevant as ever. I commend this thoughtful and inspiring opinion piece for your reading.

Finally, a reminder that our homepage has moved to be hosted on the ScienceDirect platform. Articles and issues will appear here for readers sciencedirect.com/journal/future-healthcare-journal/issues as soon as published, while the author menu includes guidance for authors Guide for authors - Future Healthcare Journal - ISSN 2514–6645 | ScienceDirect.com by Elsevier. Clicking on the ‘submit your article’ tab will take the author to our new submission portal, Editorial Manager, to log in or register on the system if they are a new user. Importantly, our contact email address remains unchanged: fhj@rcp.ac.uk so do please get in touch with your thoughts and ideas; we are always keen to hear from you. Crucially, publishing in FHJ remains free to all authors by means of a waiver of article processing charges (APCs) while readers will continue to enjoy full open access. Thank you for your support.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.