The facts of death

How is it that one man travelling abroad to end his life dominates the headlines but there is nothing to be said of the 115,000 Australians who die each year without access to adequate end-of-life care?

Often, euthanasia eclipses all other issues surrounding death and dying in Australia.

The real issue is that the ‘treat, cure, repeat’ model of health care that has successfully extended life is ill-equipped to deal with the new realities of death.

Today the typical Australian over 65 years has four chronic diseases and visits the GP roughly 10 times a year — using twice as many health resources as the average Australian.

This Australian will spend the last six months of their life in and out of hospital at least three times, participate in 90 procedures or doctor visits and be prescribed over 40 medications. They will likely die in hospital and will not receive palliative care at a cost of around 30,000 dollars for six months of life.

There comes a time when treatment to prolong life comes at the expense of quality of life. However, these decisions about treatment seem to be driven by what doctors can do rather than what patients want.

Doctors offer futile treatments and avoid genuine discussions about quality of life and death because they are ill equipped to have these conversations, they see death as a ‘failure’, and they have been trained above all else to treat.

Patients and their families have a cultural aversion to death. Often it is adult children who push treatment upon their beloved parents whilst acknowledging they would never want to be ‘like that’. Many doctors similarly provide treatment they would not want.

The cost (apart from the fiscal) of prolonging life to the extremes of frailty, age and capacity is that we are driving older Australians to look abroad to euthanasia.

There is extensive evidence demonstrating that palliative care prevents over-medicalisation, and reduces hospitalisations, emergency transfers and unwarranted medical intervention; by ensuring treatment is based on what patients and their family value in life — rather than being dictated by what doctors decide they can do to prolong life.

However, the real story of life and death without palliative care is suppressed and the much-needed change within the system — that is actually driving the euthanasia debate — is stifled.