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A conversation that promises savings worth dying for

On the eve of a federal budget looking for savings, I would like to report a medical intervention that reduces suffering, can prolong life and dramatically reduces health-care costs. The intervention itself…

We require the largest amount of health-care dollars in the last 30 days of our life. Lee Haywood

On the eve of a federal budget looking for savings, I would like to report a medical intervention that reduces suffering, can prolong life and dramatically reduces health-care costs. The intervention itself costs nothing. But first, a story.

Jim was 78 when, on an empty road, he drove his car at 100 kilometres an hour into a tree. Maybe he’d had a minor stroke – he’d certainly had others due to vascular disease brought on by a lifetime of smoking. He was badly injured – limbs, pelvis, chest, intestines – and, on paper, had no chance of survival. His doctors had two options.

a) Talk to his family, establish any wishes or preferences Jim had expressed, assure them that he would receive the best of comfort measures and allow him to die in a quiet room.

b) Operate on all the fractures and ruptures, keep Jim on a ventilator in an intensive care unit for a month (during which time he would have more money spent on his health care than he had contributed in a lifetime via the Medicare Levy) and hope that he would beat the odds.

He didn’t. I know because we chose b. Or rather, in the absence of a conscious effort to choose anything, b just happened. In acute care (where Jim arrived after his accident), heroic management is the default setting.

This “do everything default” is a heady mix of historical, ethical and legal elements. It includes acting under the principle of necessity (the notion of “emergencies”), technical imperatives (a belief that because we have the technology we are obliged to use it in all cases) and medical imperatives. These are unnuanced notions of duty rooted in a parentalistic version of beneficence - medical ethics reduced to a bumper sticker.

It takes about one minute to treat a patient according to the standard default (admit-operate-ICU), and about two and a half hours to have a proper discussion with the medical teams, the patient and the family. It’s not surprising that the default generally wins out.

The truth is dying is not only scary but also scarily expensive. It’s widely known that the last year of our lives is when the most health-care dollars are spent. It’s less well-known that essentially all of this is spent in the last 30 days of someone’s life.

As in a war, it’s the last, futile battle that is the most costly, in a number of ways. Because the costs of dying come in many forms – financial, opportunity, emotional and physical, all borne variously by the individual, the family and society.

Though not all of us are destined to die like Jim, most Australians will die in acute care hospitals, and almost all will be suffering from chronic, incurable diseases. Which is, of course, not a good fit for an acute care system founded on the duty to rescue and to cure at all costs.

This modern conundrum arose from the rapidly shifting demographic: as we die at an older age, so we die of relapsing chronic diseases. And each relapse results in an admission to an acute care hospital, where we ultimately die.

At the same time as this demographic shift, we have seen the rise of patient autonomy – all previous notions of “best interests” and “futility” now are largely resolved around establishing what the patient would have wanted. Talking to patients and their families, and taking into account their wishes is now an expected part of health care.

Before 1980, medicine largely revolved around a “doctor-knows-best” approach. The notion that decisions were to be negotiated with patients and their families started with a series of high-profile legal cases in the United States. The first “Do Not Resuscitate” orders appeared in the late 1970s, and the first mention of “informed consent” was in 1980.

Acute care hospitals are ill-prepared for this new role as the default place of death for the elderly; few have any systems in place to recognise the signs of dying early enough to have chance to provide palliation. Indeed, for two-thirds of the people receiving acute care, dying is only recognised on the last day of life. Nor are attempts routinely made to establish what the wishes of the patient would have been.

There’s now abundant evidence to back up the extravagant claims I made at the start of this article – we can prove that talking to patients and their families reduces stress, that dying outside an intensive care unit is cheaper and less painful, that cancer patients managed palliatively may out-survive those treated more aggressively, and that talking about death in advance is associated with both lower cost of dying and a better death.

So what is this is this marvellous, free medical intervention? Maybe you have guessed by now – it’s just having a conversation. A conversation that starts when you are in your final years, that asks about your goals, and about who would speak for you if (and when) you lost the capacity to speak for yourself. A conversation that continues through hospital admissions, where your doctors and nurses expect to work with you, as well as for you.

This conversation rarely happens without support. The success of the Respecting Patient Choices program, which takes a systematic approach to initiating this conversation in both acute and residential care, is due the way it trains people to introduce and continue this dialogue.

Clearly any conversation needs two sides. We need to understand that our deaths will not be with a bang but with a series of diminishing whimpers. We can all start now: ask yourself “who will speak for me when I can’t speak for myself?” Then “what do I need to say to this person?” The role of acute care is to systematically pick up this conversation, to routinely ask for this information, and to have ways to translate this into forms intelligible to the acute care system.

It’s the eve of a federal budget. You can almost hear the snap of the public purses closing all over Australia. There is a win–win out there, a conversation that can improve care and save an enormous amount of money. Can we afford silence?

This is the third part of our series Health Rationing. Stay tuned for more articles in the lead up to the May budget and click on the links below:

Part one: Tough choices: how to rein in Australia’s rising health bill
Part two: Explainer: what is health rationing?
Part four: Phase out GP consultation fees for a better Medicare
Part five: Focus on prevention to control the growing health budget

Join the conversation

55 Comments sorted by

  1. Giles Pickford
    Giles Pickford is a Friend of The Conversation.

    Retired, Wollongong

    The problem is that politicians are the most cautious (frightened?) people on this topic. They are scared of the Churches.

    Therefore the most important thing to do is begin the conversation with the Churches. They must be convinced that, although all life is holy, so also is death. Opposing death to the bitter end is clearly sacrilegious and not what our Creator wanted.

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    1. Marian Macdonald

      logged in via Twitter

      In reply to Chris Saunders

      I am with your husband on this, Chris. Six years on, I still have nightmares about my father's death, even though all accepted it was palliative care only.

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  2. ian cheong

    logged in via email @acm.org

    I agree that the topic of potentially expensive end-of-life care is something that is needed. But the intervention doesn't actually cost nothing. Being able to record a preference like organ donation or an advance health directive in advance does require some effort and discussion. Getting advice does take time of people.

    Part of what makes us human is that we care about life and the lives of others.

    We have seen the problem (Q&A last week IIRC) where families override the pre-recorded wishes…

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    1. Judith Olney

      Ms

      In reply to ian cheong

      HI Ian, you raise an excellent point about the wishes of the family being able to override those of the patient themselves. We need clear legislation to enshrine the wishes of the patient in law, so that their wishes cannot be ignored at the end of their lives.

      I have seen the problems caused by leaving the family members to make the decision to continue treatment when someone has no hope of survival. My friends mother had a massive stroke, aged 87, and was in intensive care being kept alive…

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  3. Bron Shimmin-Clarke

    logged in via Twitter

    Brilliant article. It reminds me of the 'open letter' from a palliative care doctor a few years ago. Can't find the original link, but this article mentions it: http://www.australiantimes.co.uk/news/in-australia/doctor-pleads-to-end-suffering-2.htm

    @ian cheong: I think time spent in talking is never wasted - and if it improves the quality of life (ie the little there is remaining) and costs exponentially less, then it is a conversation we all should be having.

    @Giles Pickford: it doesn't need to include the churches or the courts if this is a patient/doctor decision. We have many years experience in doctors being able to advise patients and this article and the open letter are advice from doctors.

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  4. Emma Beckett

    Doctoral scholar, Human Molecular Nutrition Laboratory & Casual Academic at University of Newcastle

    Dr Saul,
    I saw you present on this/similar topic at TEDxNewy and I was so impressed with your words both then and now. It is a difficult conversation for many people to have and it is commendable that you are encouraging people to have it.

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    1. William Boeder

      logged in via LinkedIn

      In reply to Emma Beckett

      Twas some many years ago now, somehow the conversation arose about the views expressed by Life Insurance entities and how they fought against Euthanasia in order to cling to cling to ensuing death payouts as a result of their desire (or was it avarice) to hold off until the very last fully extended moment in time before having to honour the life Insurance inevitability when death comes to pass.
      Now such as the Life Insurance Industry, (with around 15% only ever being paid out from the many many…

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  5. T Craven

    Urban professional

    Excellent article although I have a few comments. Firstly the article focuses on choice - the choice to have treatment or not with full disclosure of treatment. This needs to be completely separated from cost as a driver, otherwise there is the potential for conflict of interest, particularly by politicians and economists. Secondly, as there is choice, so must there be choice to either have treatment or not - even if others think it is futile. Otherwise there is only an illusion of choice. If the…

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  6. Melissa Bloomer

    Lecturer, School of Nursing and Midwifery at Monash University

    I whole-heartedly agree with every word. However, despite the RPC Program and various other campaigns and programs designed to encourage people to talk about their wishes, the reality is that very few do, or they leave it too late. As a former ICU Nurse I saw too many patients subjected to weeks of suffering and pain all because the conversations were 'too hard'. Instead of focussing on comfort care and allowing natural death to occur, these patients were subjected to numerous interventions and…

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    1. Judith Olney

      Ms

      In reply to Melissa Bloomer

      So what happens when family members disagree, or have vastly differing views, (particularly religious people), than other family members? Not all states have legislation that enshrines the patients wishes, above those of the family members.

      What about family members that live far away, or are estranged?

      I wouldn't want my family arguing over whether to treat me or not, in my last days, weeks, or whatever. I know families where this has happened, and the wishes of the dying person were ignored. These bitter arguments lasted long after the person passed away, and there is little counselling or help for those that have to make what is an impossible decision for many, after the decision is made.

      If we want people to have this conversation, we need to provide far more help for those that have to make these kind of decisions, or have national legislation, so that people can make their own decisions before they are in a position where that is no longer possible.

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  7. Paul Burton

    Professor of Urban Management and Planning at Griffith University

    I recently attended a presentation by Dr Sarah Winch of UQ in which she outlined a book she is finalising called, 'Best Death Possible: a guide to dying in Australia'. This offers a wealth of practical experience on how to deal with many of the problems raised in Peter Saul's excellent piece. Perhaps Sarah could post details of it?

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  8. Tim Comber

    logged in via Facebook

    It would be great if my car license carried my 'how to die' wishes! It already has donor information.

    I think it is incredible that we can spend so much prolonging a dying person's life when that money could be spent on improving the health of children. To put it another way it would be good if the legislators could be shown a picture of an old fart like me and a bright-eyed, smiling child and asked to choose which one dies.

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    1. Peter Ormonde
      Peter Ormonde is a Friend of The Conversation.

      Farmer

      In reply to Tim Comber

      And we do that all the time Tim.... make this decision by default.

      We do it with our budgets and resourcing. Third world health problems within a day's drive of an MRI machine.

      And we strip the terminally ill of dignity and respect - all to end with the same outcome... where death is a failure no matter the age or circumstances.

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    2. Chris Saunders

      retired

      In reply to Tim Comber

      This is all very nice altruistic stuff and I am certain you are very sincere. But I ask whether you are making a false connection here. I don’t think that you really can make a connection directly from your own refusal of expensive care that the cost savings of it will then be transferred to a more worthy person (a doubtful proposition in itself) but in your estimation a child. Such cost savings could go to any number of uses depending upon the proclivity of our elected officials; subsidising private health insurance payments, expanding the profits of private hospitals, increases to parliamentary salaries to name any number of possibilities. In any case, the surgeons need to practice.

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    3. Eric Glare

      HIV public speaker & advocate

      In reply to Chris Saunders

      Chris you seem to have missed the size of the problem:

      "The truth is dying is not only scary but also scarily expensive. It’s widely known that the last year of our lives is when the most health-care dollars are spent. It’s less well-known that essentially all of this is spent in the last 30 days of someone’s life."

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    4. Chris Saunders

      retired

      In reply to Eric Glare

      Thanks Eric for your concern. Yes, I was being a bit frivolous about surgeons needing practice, but my point was that each life is worth the living, and that I doubted very strongly that such altruistic choices as Tim was proposing should or would have to be made. I agree with Sue Ieraci’s comment below that if a patient, no matter how old they are, is truly a hopeless case for survival in spite of surgery then the attending physician does usually tell that person and family in plain speech. I…

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  9. Carol Daly

    Director

    This is a very important and excellent article, thank you.

    I only hope that when my turn comes my Health Directive wishes are adhered to. I don't want my life prolonged through all possible treatments; each of us has a use by date and I've had a good life. I would like a good death, please.

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    1. Melissa Bloomer

      Lecturer, School of Nursing and Midwifery at Monash University

      In reply to Carol Daly

      Hi Carol

      You raise a couple of really important points:-

      1. Just because you have an advanced health directive, doesn't mean it will be followed. Families can and do override these documents.
      2. Charlie Corke, an Intensivist from Geelong Hospital, VIC talks about how his father (when dying) asked if he could 'only die once'. That is, he didnt want to be resuscitated and be made to reattempt to die. Food for thought....

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  10. Christopher Pitt

    logged in via Facebook

    I am going to talk about two things here: autonomy, and polypharmacy.

    I have been a doctor for 15 years and a GP for 10 of those, and I have been working in a number of nursing homes over the last 12 months. I've noticed in my small, but growing, experience with the dying, that dying is as individual as living. The only constant is individual choice, the fundamental ethical pillar stemming from the innate autonomy of every human being. It's true that people need to have a conversation about…

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    1. Katie Lee

      Medical researcher and sometime journalist

      In reply to Christopher Pitt

      When my grandmother's doctor discussed her treatment with us after her diagnosis with dementia, the thing that surprised me most was how many pills she was taking and what they were all for. His advice, which we took, as that she stop taking more than 3/4 of them, because they were either intended to stave off chronic diseases (which were unlikely to develop before the dementia killed her anyway) or were to counteract side-effects of the other medicines. Anxious as she was about losing her ability to manage her daily life, it was a relief to her to not be trying to remember 3 times a day which pills she was supposed to take.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Christopher Pitt

      Great post, Christopher.

      The elderly seem to be at greater risk of being on too many medications if they go to a round of sub-specialists. The cardiologist who prescribes the blood-pressure-lowering medications may not see the old person when they get dizzy and fall, and then suffer bleeding due to their blood-thinning drugs.

      There comes a time when the benefits of preventative drugs are exceeded by the risks - be they blood pressure tablets, anti-coagulants, cholesterol-lowering agents or anti-diabetic medications. Life must eventually end - and some organ has to fail first.

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    3. Jan Burgess

      Retired

      In reply to Christopher Pitt

      Thank you for this post - what you say about "polypharmacy" is so true.

      I've recently been staying with some old friends. The husband is 76 and the last time I saw him (2 years ago), he was frail, weak, stooped and completely out of energy. I thought it wouldn't be long before I would get a sad call from his wife. However, this time he is bright, alert and relatively full of energy and keen to do things. He stands up straighter and has much more muscular strength.

      The difference is that…

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  11. Brian Myerson

    Director of not for profit organisation

    Peter, thank you for a most thought provoking article.
    It all comes down to end of life care for the patient AND the family. With expert and compassionate care, a well trained doctor is the most appropriate person to lead the family through this very difficult process. The conversations with the family is part of a continuous process to take the family through this and should include many topics including organ donation where appropriate. While the treating doctor might be very busy with the patient, perhaps it would be appropriate if another doctor was there to support the family through the many decisions that need to be made.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Brian Myerson

      Brian - I suspect that, in trying to be less paternalistic, and allowing families to express their desires, the medical profession might sometimes be stepping back from providing helpful advice.

      It's not enough to ask a scared family ""what would you like us to do?" The only appropriate answer to that question, at times of stress, is "please do everything."

      A more appropriate approach is to explain what is happening to the dying person, what therapies (if any) might change the outcome, and whether these therapies might prolong suffering. There is no obligation for medical staff to provide futile care, and it is irresponsible to provide it simply because there has not been courage or skill to have the conversation.

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  12. Bob Down

    logged in via email @bigpond.com

    Put simply, my life my decision. The speed hump is not having had that vital conversation with your family, as well as a note on instructions to only intervene if the chances of survival are above 70%, with that 70% also applying to the quality of life index if I was to be deemed a good chance of over coming some injury or disease. There is no leeway in my instructions to keep my alive for the end result to be nothing but existence in a ward or home till I do pass away. If I cannot go home after…

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  13. Michael Glass

    Teacher

    Very good article. Of course there is no absolute answer to the problems outlined here. However, I think it would help if the default position was that the expressed wishes of the patient should be honoured. Certainly this should apply to organ donation and it should also be applicable to terminal illness.

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  14. Michael Guy

    Clinical Psychologist

    My father spent four years in a Nursing Home. He bought the topic up when still well and I was frozen. I deeply regret not being able to take that conversation further.

    My mother had been a nurse and stopped treatment for Leukaemia leading to her having palliative care at home for the last week of her life. Until she said stop the doctors proposed all manner of treatment. My sister said to them she has leukaemia but they still persisted in suggesting treatment.

    As you have noted and my…

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    1. Judith Olney

      Ms

      In reply to Michael Guy

      I actually think people would like to take more responsibility for their own deaths. In our society it seems that refusing treatment is seen as tantamount to suicide.

      If we ask a relative or friend to help us end our lives, against a doctor's advice, even when the prognosis is terrible and will lead to our eventual death anyway, those friends or relatives can be charged and jailed for their assistance.

      How many times have we seen this already in this country? We basically force people who have terminal illnesses to suffer until the end, rather than helping them end their lives before they are in great pain and suffering, knowing that they will die anyway. Palliative care can only do so much.

      Wouldn't it be better to allow people with terminal illnesses to decide for themselves, when they want to depart? Or people who believe they have no quality of life, and are not likely to have any improvement in their quality of life, do the same?

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  15. Ross Kirkman

    Consultant Psychiatrist at Psychiatry

    Excellent article and you are to be commended for opening up the discussion that needs to be had in the community. I think there needs to be more education of the public about the fact that such a huge amount of the health budget is spent on the last 30 days of a person's life. Once this fact becomes more well known it will generate more thought about how we die well.

    As a doctor I think a lot of the problem lies with doctors who are well trained to intervene and poorly trained to not intervene…

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  16. Peter Hindrup

    consultant

    The proviso is always ‘will I return to something akin to where I have been without this accident/illness?

    If the answer is ‘no’, then leave me to die. The idea of preventing death is really offensive to me.

    This is not a new or recent idea for me. I have had life threatening illnesses/events throughout my life and the attitude has always been the same. Full recover or death, clearly stated when the odds were being out for me.

    Perhaps the other change in peoples thinking ought to revolve around taking responsibility for ones own death, and not expecting others, including medical staff to intervene.

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  17. Michel Syna Rahme

    logged in via email @hotmail.com

    I'm still young, but all I know is that if I was in my 50s or 60s and had children and the consensus of Doctors was that there was a chance to beat a disease or recover from an accident and not be in a vegetative state, I would fight fight fight for life. If I was in my 70s or 80s or 50s or 60s and the consensus was no chance of surviving and all I had to look forward to was worsening condition, increased severe suffering, and becoming a burden to my family and the health system which could be directing…

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  18. John Kelmar

    Small Business Consultant

    My mother was 87 when she died. She was told by her doctor that she needed a triple heart bypass, and that she would live for another 5-8 years. She agreed.

    However the doctor lied.

    My mother was stuck in hospital for the last six months of her life and was very angry at the doctors for their lies. She felt that they were only trying to scam as much money as possible from people like her.

    When my turn comes, I will make my own decision, and not finish up being unhappy and bed-ridden for many months just so some doctor/hospital/business can make massive financial gains from my illness.

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    1. Bill Slater

      Public hospital clinician

      In reply to John Kelmar

      This raises the question of professional and financial conflict. Usually the doctor (surgeon) in favour of a procedure (operation) will be the person remunerated for that procedure.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Bill Slater

      I'm not sure that the motivation is likely to be financial in this case - surgeons generally don't relish taking on high-risk cases or being investigated for a death.

      What's more likely is a type of "spectrum bias" - now that many people have their coronary arteries stented by cardiologists, the surgeons tend to see older patients with more severe disease. People who were once denied coronary artery bypass surgery may now be considered candidates due to this spectrum shift, and improved methods such as beating heart surgery and sophisticated intensive care post-operatively.

      What is crucial is what this lady was told by the surgeon. It seems unlikely that there was a 100% guarantee of living another 5 - 8 years - what odds, and alternatives, was she given?

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  19. Anna Zamecznik

    Broadcaster

    Having spent a lot of time in hospitals and nursing homes, I have become staunchly anti-euthenasia but not against stopping treatment. When my great-uncle stopped eating due to severe mouth ulceration (which was being treated by nasty tasting creams), and the hospital proposed a feeding tube or letting him die of starvation, after a very traumatic family discussion we chose not to put in the feeding tube but I brought in some yogurt and honey for him, Teh yogurt and honey cleared up the ulcers and…

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  20. Colin MacGillivray

    Architect, retired, Sarawak

    Isn't it time for a law to be established so that the wishes of the person, formally recorded, are sacrosanct?
    The law should state that once done, the family have no input. Hospital staff would tell the family what the person wanted and suggest that the person knew best, and then do what the instructed.

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  21. Bill Slater

    Public hospital clinician

    Thanks very much for this article Peter I wholeheartedly share your sentiments. The silence does not only prevail in the broader community - it is also prevails in acute care facilities. You are an acknowledged leader in this area yet even in your closest area of influence (the hospital in which you work) there was no conscious effort to choose option a. We as a profession have a long way to go, at least the journey has started, the destination is definitely worth it.

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  22. Lorraine Barbara Retallick

    ICU Liaison Nurse

    I have just read this incredible article , as an ICU nurse of many years ans attended many family meetings have these difficult conversations with families which have determined what "Fred's" wishes would be if put in this very situation, as difficult and tragic for the family as this is ultimately the family , through tears of sadness and sometimes relief they agree that there are worse fates than death and that death is the best and only option for their loved one and that they do not make this…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Lorraine Barbara Retallick

      Many ICU staff do a wonderful job of helping families through these difficult circumstances, but sometimes the patient is only in ICU due to a failure to plan and communicate well in advance.

      I see it as the role of GPs and hospital staff, as the person gets more frail, to initiate conversations with both the patient and family that call a spade a spade, and talk about what they want to happen in the final moments - in detail. Sometimes this means leaving the very disabled in their nursing home bed, surrounded by their familiar surroundings, rather than rushing to hospital to die amongst strangers.

      A difficult conversation in advance can make for "a good death" when the time comes. Even though I work in an acute care environment, I see this role as being just as important as working to save life.

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  23. Jan Burgess

    Retired

    Thank you so much for this article. It is very timely.

    Being within touching distance of 60 and having recently been diagnosed with a potentially life-changing problem (breast cancer), I have had this discussion with my family and made my wishes very clear. I have no problems with where I am going regarding my treatment.

    However, I am concerned that I will have some sort of accident and wake up in ICU with no prospect of normal future life. There needs to be some sort of centrally held database…

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  24. Bob Simpson

    Project manager

    Peter, and everyone else, thank you. To me, this is a great conversation. I don't have the knowledge or experience that so many of you have, but you have all given me pause for thought. One thought is, "how will I constantly re-open the question with my wife, children and grand-children?" A second thought is,"what is the one pro-active idea that can be moved forward out of this conversation?" E.g. the legislated "sanctity" of a person's wishes for their treatment at or around the time of death! Or, some other! A third thought,admittedly coming from the presuppositions of my belief structure, is, "why do so many people find death "scary?" Once again to you all, "thank you." Bob

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  25. Louise O'Brien

    Marketer.Communicator. Observer

    The medical records of all Australian citizens aged 75 and over should automatically be made eHealth records.

    Medical professionals should then check to see if every one of these people have made a decision regarding whether or not they require intervention in the case of an emergency medical situation and they should ensure that the eHealth records are kept up to date with the person's wishes.

    One other issue I believe should be addressed is the cost of dying. I believe that every major public hospital should have an Alkaline Hydrolysis machine so that people can have their bodies disposed of free of charge if they wish. To my thinking, memorial services are much nicer than funerals, no one need to see the coffin or the corpse. Below is a link about the machines.

    http://www.aquamationindustries.com/index.html

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    1. Chris Saunders

      retired

      In reply to Louise O'Brien

      I assume you mean this scheme to be voluntary? How does anyone know how they will feel at the time? I personally want to see the corpse and even follow the coffin out to the graveyard, or watch it disappear behind the curtain headed for the furnace. Harrowing it may be, but I think we owe something to the dead. The wake is for the living. As to the AH machine, don't you think hospitals are busy enough saving people? Or, do you think it could be connected up to the hospital kitchen and patients could enjoy protein and fat in their mash.

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    2. Peter Hindrup

      consultant

      In reply to Louise O'Brien

      Louise: I'd rather an attachment be made to health records.

      One concern, for me, is if bodies are handed to a hospital for disposal, the temptation to let sticky little fingers take whatever they thought they wanted, would I fear, be too great for some to resist.

      However i cannot see why apiece of board and a wrap around sheet cannot be used for whatever transport is necessary, and then toss the lot in the fire.

      Certainly, and I once worked in the industry, the 'preparation' is offense, and the cost of coffins with the 'trimmings' is exorbitant.

      Not too keen on the idea of being dissolved in water --- never did have any liking for the stuff!

      ,

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  26. Louise O'Brien

    Marketer.Communicator. Observer

    It would be good if The Conversation could do an article about Advanced Health Directives, the options available when people are filling these forms out and how medical personnel could be encouraged to discuss these forms with people who are terminally ill, elderly and/or in nursing homes. The details of Advanced Health Directives that have been completed by individuals should be put on the eHealth records system to ensure their wishes are known.

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    1. Louise O'Brien

      Marketer.Communicator. Observer

      In reply to Reema Rattan

      Good article, however it would have been better if it had included information about how people could have the details of their Advanced Health Direction registered on the government eHealth system, so that the information can be easily found by health professionals. This step should be standard practice but it may not be.

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  27. Anne T. Jarrett, MS,RPh

    logged in via LinkedIn

    I get it! Who I do feel sorry for are patients who do not have an informed healthcare advocate. Years ago when I first started working in an inpatient hospital setting, I remember asking what DNR meant. When they told me, I was horrified. I said, "You mean they won;t try to help them?" I didn't understand then, but I do now, both professionally and personally. It has nothing to do with a doctor "playing God". or the amount of money it costs. Of course, not every situation is the same, but when families let guilt without information make decisions for them, often patients suffer needlessly, Have you ever seen breathing corpses with no chance of ever having a good quality of life again? That's sad. I can understand people having trouble letting go and is a hard decision when the patient has no advanced directives, but there are things worse than death. All of us will die. We must face that.

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