Author: Dr Matthew Doré – Palliative Care Consultant in Northern Ireland Hospice and Royal Victoria Hospital, Belfast  on his reflections from the 2023 Palliative Care Congress in Edinburgh

The start of a new philosophy?


Is a bagel a bagel without the hole?

The hole is nothing, an emptiness a void positioned in the middle of lovely cooked cinnamon dough. But, without it, the cinnamon dough loses its identity as a bagel! Thus, the hole isn’t a nothingness, it is a something integral to the bagel. (1)

This is what I have been thinking about since the Palliative Care Congress (PCC) in Edinburgh 2023. I know, I know, what a sad man I am! Pointed out to me by David Edmonds, Ariel Dempsey and John Mulder, all of whom spoke at the PCC. Uncertainness is something tangible in a sense, bereavement is something akin to a hole, communication is something in the space between, compassion is something intentional and integral to the identity of palliative care. All of these fundamental elements to palliative care and more are often seen as an empty space not as wholly important as the bagel itself. I.e. the medical care, by our wider colleagues, managers and leadership.

Bagelology, a phrase I have just coined, is the ‘study’ of the loss of identity of something by the removal of something not seen.

The hole isn’t a ‘nothing’ it is a ‘something’ integral to the identity of a bagel. As Mark Taubert and James Norris in their excellent plenary said in regards to artificial intelligence (AI), is this the elephant in the room? A ‘bagel’ with no hole? Purely AI driven healthcare void of the spaces? As Rachel Clarke in her closing reported, is the shape of healthcare changing to a cold impersonal structure we need to challenge?

I won’t try and segue all the sessions into a bagel shape, but you get my hole point. The juicy dough of science is vital, the creativity of Paul Howard and Workforce innovation is all so important. The symptom control, the protocols and procedures are edible sustenance. But despite my annoyance at the shape of a bagel, what is the shape of palliative care? I suggest it is bagel shaped and we should constantly remind ourselves it needs to be. A perfect balance of dough and space. Science and Art.


A few memories from this years PCC, including not yet seen photographs from the infamous Memento Mori Disco organised by James and the Digital Legacy Organisation:










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