Death is not always sudden. Most of us will die slowly, not always peacefully, in an uneven series of ups and downs until it’s over.
Most people accept the inevitability of death, but find it difficult to talk to their family or their health professionals about how they want to die. This can be counter-intuitive for doctors as they have been trained to save life at all costs. The lack of willingness to start the conversation about dying is a big problem and can result in many patients spending their last days, months and years of their lives in and out of hospital, undergoing invasive treatments, without hope of a cure, which is not the best thing for them or their families.
After discovering that many doctors had not spoken about dying to their terminally ill patients in the intensive care unit (ICU), Barwon Health’s University Hospital Geelong decided the doctors needed some practice, and designed a two-day training course called iValidate, which gives doctors the chance to work on their skills with actors. The trick is to identify patients who have limited time left, and to talk to them before their condition gets much worse and other people have to make decisions for them.
But there is growing awareness within the medical community — and the public — that we need to re-examine the way we deal with death. And government has taken notice. A Victorian parliamentary inquiry report released in June recommended a number of reforms to the medical system’s approach to end-of-life care, including a framework for legalising assisted dying.
Many practitioners believe that earlier discussion of palliative care or other underused resources, such as advanced care planning, only benefits patients. With more knowledge, they can make choices about how they want to spend the rest of their life.
But advanced care directives – special plans that detail a patient’s medical wishes in the event of an emergency – are relatively rare. Less than 1% of Australians over 70 have one. A number of organisations have developed resources to get people started. Death Over Dinner helps individuals plan dinner parties where death is discussed. The Groundswell Project organises Dying to Know Day each August 8. Palliative Care Australia has a Dying to Talk discussion starter pack.