Life before death

 

The end isn’t inevitably nigh but it is the end. For all the doomsday discussions about death what we have failed to consider is life — life in the years, months and weeks before death.

An average Australian in their last six months of life:

• Has at least three hospital admissions
• Participates in 90 procedures or clinic visits
• Is prescribed over 40 medications
• Dies in hospital from heart disease at 85 without palliative care
• At a cost of roughly $28,000 per person

Is this the life prior to death that older Australians suffering chronic disease want?

This ill-managed experience of life has been eclipsed by discussions about death.

Death has become dichotomised — as either good or bad. Choice has come to mean deciding when instead of where, how or who with, one dies while the experience of life before death gets passed over.

Palliative care has been dissected and emerged misunderstood as being able to solely provide a ‘good death’.

But palliative care can also do so much more than that.

It can alleviate suffering from symptoms whether they be physical, psychosocial or spiritual. Patients and their families in partnership with clinicians ensure that any treatment received contributes to quality of life.

Hospital admissions are avoided, medications are rationalised and care is provided based on what patients want and need in order to live a life desired before death.

Patients suffering from heart failure in Australia describe their experience as one of uncertainty about their condition and a wish to focus on comfort rather than cure — meanwhile only 15% of cardiologists think it is their job to discuss end of life preferences with their patients.

How we die is worthy of our attention but how older Australians live during their last months is just as, if not more important.

Properly understood, palliative care can ensure a ‘good death’ — but it can also provide a better life.