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Let's talk about dying

Let's talk about dying

Toby Hall - The Age
27 August 2017

Australians are rubbish at dying.

Don’t take it personally, so are most people who live in the developed world.

Anxiety about death has grown deep roots. Dying is something that has become hidden away and to be desperately resisted at all costs.

Advances in public health and medicine may have led to giant leaps in life expectancy but they’ve also created a dependency on treatment and intervention ‘at all costs’ as we try to deny the inevitability of death.

And in the vacuum created by our disconnection from dying, we have allowed fear, misinformation and myth to flourish. Death is portrayed by an ill-informed media as inherently painful, undignified and traumatic – a depiction, incidentally, that is completely at odds with the experience of the vast majority of the people we care for in our palliative care services.

Is it any wonder that public support for assisted suicide is as high as it is?

The medical profession bears some responsibility for where we find ourselves.

We don’t train or support our doctors to say ‘no’ when dying patients request more treatment, no matter how burdensome. In fact, many are afraid to say the word. Some think saying ‘no’ reflects a personal failure.

It is easier to write a prescription, or provide a new trial treatment, than to spend time talking to and explaining the likelihood of death to a patient. We don’t train our doctors to have these challenging conversations, and we can’t blame them for avoiding them.

As a result, many terminally ill patients in Australian hospitals are provided with unnecessary, unwanted and sometimes futile treatment. For some there may be a small life-prolonging effect, but it often comes at great cost and usually guarantees the patient a hospital death. For many others these futile treatments come with no measurable benefits at all.

Equally our healthcare professionals are not taught to routinely ask about patients’ wishes for care, or engage in Advance Care Planning which would save an enormous amounts of unnecessary suffering and distress. Alarmingly, nor are they trained in the fundamentals of palliative care.

What a depressing position to find ourselves in.

There is an increasing belief in modern society that we can codify everything, make a law, introduce a regulation, and we will be able to solve our problems, eliminating any and all unpredictability.

Assisted suicide is an effort to do the same with death, but frankly, we’re kidding ourselves.

The experience of death and dying, like birth, can’t be scheduled to the finest detail – no law or medication can achieve this, including assisted suicide.

Every system of assisted suicide or euthanasia the world over has experienced errors or had its safeguards manipulated.

It’s not uncommon for people participating in assisted suicide to undergo complications – vomiting, seizures, failure to experience coma – symptoms that are anything but the clean and peaceful death its proponents promise.

I look at the Victorian assisted suicide model – the 68 safeguards, the 282 mentions of the word ‘safe’ – and can’t help but think of it as folly.

As internationally respected doctor and author on death and dying, Atul Gawande, says: ‘We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way.’

A ‘pill’ should not be seen as a panacea for dying, any more than it is a solution for anything else life throws at us. 

Assisted suicide is not the answer to addressing our anxiety about death. 

That path is much harder but will ultimately deliver much greater rewards.

Firstly, we need to properly resource palliative care so that people, whether they’re in our big cities or rural areas, can access 24-hour quality care that includes the ability to move home from hospital and offers real and practical support for families.

The biggest fear people have about dying is becoming a burden to their families, let’s remove that.

Running alongside we need a systematic and sustained public education program to encourage a community conversation about dying, the goals of medicine when there is no cure, and preferences for decision-making.

Doctors and nurses need communication skills training, and be supported to talk to their patients about dying.

And we need to increase support for Advance Care Planning to give all Australians the opportunity to specify the type of care they would like at the end of their life and, importantly, what they don’t want. The Victorian Government’s efforts in this specific area are to be congratulated.

Proponents of assisted suicide are constantly urging Victoria’s politicians to show courage by supporting its introduction.

But if assisted suicide is legalised in Victoria does anyone really think that the fear and anxiety around death will disappear?

Far more courageous is the MP who looks past the superficial appeal of assisted suicide and recognises that nothing in life – or death – is ever that straightforward and simple.