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Give death a chance; why we need to stop demanding that “everything be done” to prolong elderly lives

Dr Clare Skinner, an emergency medicine registar and health reform advocate, recently wrote this article, encouraging us to start thinking about how we want to die and related issues of how we want our health dollars spent.

Do we want a high-tech death, involving expensive but futile interventions?  Or do we want to refocus health spending and priorities towards the areas that might make a real difference to the community’s health (such as early childhood)?

Related questions sprang to mind for Dr Peter Arnold while perusing the latest annual report from the Private Health Insurance Administration Council.

Arnold, a retired GP and regular contributor to public debate, writes:

“Faced with wounds which could rapidly become infected and gangrenous, with fatal results, Napoleon’s surgeon-general, Baron Dominique Jean Larrey, instituted a method of sorting – triage, [from the French ‘trier’ to sort]; those soldiers who could return to the battlefield were given priority attention, followed by those who could be treated but were unlikely to fight again. Those likely to die of their wounds were given painkillers and made comfortable.

Civilian illness requires a different primary criterion – giving everyone a fair chance of a decent life.

With universal high quality health care rapidly becoming unaffordable, our society needs to re-focus our spending. The charts below, from the 2009 Annual Report of the Private Health Insurance Administration Council, demonstrate that most money is spent on hospital care of the aged, many of whom have little life expectancy, and those lives often of poor quality.

Death, at an advanced age and after a lengthy illness, is part of living. We must stop demanding that “everything be done” to prolong grandpa’s or grandma’s life. Let’s all give enduring power of guardianship to someone we trust, who will avoid this massive expenditure on futile treatment.

Let’s be fair to the young and middle-aged, who have not yet enjoyed their natural span.

The starter’s gun towards futile treatment is that phone call to the ambulance. To keep the old man or old woman, dying after a lengthy illness, comfortable and pain-free in their own bed, call in the GP and the district nursing service and, if necessary, the palliative care team. Avoid pulling that futile treatment trigger by phoning the ambulance.”

Hospital.Costs

HospitalSpending

Comments 4

  1. Bogdanovist says:

    I agree for the most part, but this article seems to leave the responsibility on the family, who can only make a good decision if they are given the full unsweetened information about an individuals condition.

    For example, my Gran spent the last 3 or so weeks of her life (in her late 80’s) in an ICU. It was only when she finally died that the doctor explained to us that she was never a chance she was going to recover. Had we known that we would have pulled her out to her local hospital, in her own town, which has an appropriate palliative care unit, where her friends and family could have come to see her (the large hospital she died in was 2-3 hours away in Sydney). She would have been more comfortable and in a calmer environment, and it would have been much much cheaper for the tax payer. She would have been very happy with this (she kept telling us how much she hated being in the hospital and just wanted to go home and be at peace).

    The only reason we did not do this was because the doctors and nurses kept giving us hope and the impression that she had a chance of recovery. For instance, after performing an emergency tracheotomy, they told us to make sure she held the bandage over the hole down when she talked, so that the wound would close up. Clearly this implies that she has a future (when in fact she died a few days later, as the doctors apparently always expected).

    Perhaps there is a fear from Doctors that families will become angry if they perceive that not everything possible is being done for Granny, and this is why they were less than frank with us about her condition. Maybe, but I think a lot (most?) people these days do understand that there is choice between dying more peacefully or living a fraction longer in a terrible way, and would prefer the former. However, without the Doctors being crystal clear about whether a person faces that choice or whether they have a temporary and curable ailment then that choice can’t be made.

  2. Fiona says:

    Come to Canberra, where we’re about to sign over the hospice to the Catholic church… they know how to prolong life.

  3. Tim Woodruff says:

    Agree with the general comments of Peter Arnold. What is being suggested should happen. There is a problem however, with calling the GP, district nursing service, or palliative care team, in many areas of Australia. They aren’t available when needed. Home visits by GPs are now I think about 10% of the level of 20 years ago. It may cost $100 out of pocket, or more get such a visit. The same situation arises in nursing homes, already understaffed, and patients reach crisis point which sends them to Emergency where doctors trained to save lives do so.
    tim woodruff
    doctors reform society

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Population Health Congress 2015
2016 conferences
#AHHAsim16