It is a sad reality that perfectly well older Australians are looking into their futures and finding solace in the potential of physician-assisted suicide.
Irrespective of what this says about our society and our care of the elderly, the death myths driving the desire for a one-way ticket to Victoria deserve to be critiqued before it’s too late.
Myth 1: Palliative care doesn’t work
There is sound evidence that palliative care not only provides relief from suffering — physical, psychosocial and spiritual — at the end of life but that it also improves satisfaction with care and rates of depression. The benefits of palliative care extend to families and carers.
In Australia, as few as one to five per cent of people who receive palliative care have a sustained request to hasten their death.
Myth 2: Palliative care hastens death anyway
Despite popular belief, there is no evidence that quality palliative care — by relieving suffering — hastens death.
In fact, the landmark trial for palliative care found that those patients with lung cancer who received palliative care despite not receiving any ‘active’ treatment actually lived longer than those receiving chemotherapy. This was thought to be due to the reduced rates of depression among palliative care recipients — as depression likely hastens death.
Myth 3: Death is inevitably horrible
The overwhelming majority of patients who receive palliative care are not in pain when they die, do not request to hasten death, and are not fearful.
However, the overwhelming majority of older Australians who die from chronic disease do not receive palliative care. Dying within a health system that is geared towards curing and treating instead of caring and comforting means death has become dreaded.
Death is not inevitably horrible. It is the lack of palliative care and the way the system manages death that arouses dread.
Myth 4: 70 per cent of Australians want to die at home
A South Australian study in 2006 asked participants as young as 15 where would they like to die if they had a terminal illness; 70 per cent said ‘at home’. More robust research has asked people with a terminal illness and their families where they would like to die and where they would like to be cared for.
Most people want to be cared for at home but there is an increasing trend for both patients and their families to request a more supportive clinical environment in which to die. Death in hospital is not the problem — death without palliative care is.
Myth 5: Palliative care is about dying well
Palliative care has more to offer than a ‘good death’. A wealth of Australian and international evidence shows that palliative care improves quality of life for both patients and their families. It does this by managing symptoms well and supporting patients to be as active as possible prior to death.
The peak of the baby boomer generation will reach 65 years of age in 2021 most of them will have four chronic diseases and with increasing frailty will die at very old ages (most don’t want to go the way their parents did).
We have four years to create a health system that can offer better community based care for older Australians with chronic disease.
Four years to re-arrange the fragmented health system and do away with the myths shrouding death.
We have even less time to provide a view of the future that isn’t so bleak as to inspire a desire to check into hotel Nembutal.
Dr Jessica Borbasi is a medical doctor and a research associate at the Centre for Independent Studies. She is the author of Life Before Death: Improving palliative care for older Australians.
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