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Some wide-ranging conversations on death and dying

In Canada, The Globe and Mail has recently published a detailed series on death and dying, “Navigating life and death in 21st century critical care”.

In Australia, The Conversation has recently published a series, “Talking about death and dying”.

Thanks to Reema Rattan for providing this summary of the series:

We make all kinds of choices in our lives but we are not permitted by law in Australia to have a say in whether we die in pain in an intensive care unit or at peace surrounded by our loved ones. This series looks at the issue of death and dying from a range of perspectives – from an intensive care specialist and an oncologist to a philosopher and a retiree suffering from terminal cancer.

Illustrated with stories about people at the end of their lives, we hope this series will inspire you to start a discussion about why we don’t let our pets go through prolonged suffering before their deaths but we allow it for humans.

A personal account of life with terminal cancer

Geoffrey Drummond writes:

Bowel Cancer? Me? How could that be? I’ve been so fit throughout my life, eaten porridge, been as regular as a clock. My diet was always well balanced. There has been no history of cancer in the family. Cancer? Me?

Bleeding led to a CT scan, and, after that, there was no doubt about it. I was told by the surgeon that bowel surgery was very successful and so about eight years ago, I had the first operation. But this turned into eight, each worse than the previous one. And, I’ve ended up with a bag and terminal cancer. Read more

***

A challenge to our leaders – why don’t we legalise euthanasia?

Richard Denniss writes:

It’s often said that the only certain things in life are death and taxes. In reality, of course, if you’re willing to pay lawyers and accountants enough, you might be able to avoid taxes. But no matter how much you spend on doctors, the best you can do is prolong your mortality. And for some, the cost of extending life isn’t financial, it’s the pain and anguish associated with delaying the inevitable.

Most people would like a quick and painless death, but unfortunately that’s the exception. Death is more likely to come after a long medical struggle with an incurable illness. While death is certain, its timing isn’t, partly because medical science can now prolong the dying process considerably.

For some, “fighting to the end” provides purpose. For others, it can seem painfully pointless. Read more

***

Planning your endgame: Advance Care Directives

Colleen Cartwright writes:

Many people in the community fear the end stage of life, not because they’re afraid of dying but because they fear such things as the loss of mental faculties, control and dignity, being a burden on family and not receiving adequate pain relief.

This is often the result of having witnessed distressing deaths of loved ones. Every competent person has a right to refuse treatment – even life-saving treatment – and the cases above are actually assault under the law in Australia.

Advance Care Planning provides a way for competent people who fear aggressive end-of-life treatment to record what kind of medical attention they would or wouldn’t want if they no longer had the capacity to make their own decisions. Read more

***

Body or soul: why we don’t talk about death and dying

Malcolm Parker writes:

A decade into the 21st century, a number of people still die unjustifiably delayed, painful, poorly supported and undignified deaths in Australian hospitals and other health-care institutions.

This happens despite considerable progress in the area of official statements and legislation designed to give greater control of dying to individuals, and to make the dying process as comfortable as possible.

The progress has resulted from the interaction of many factors, including the education, the relative secularisation and democratisation of society, and the rejection of traditional authorities (including medical paternalism). Read more

 ***

Death and despair or peace and contentment: why families need to talk about end-of-life options

Melissa Bloomer writes:

People over 65 years of age account for 13% of Australia’s total population and that figure is projected to rise to 25% by 2056. Chronic illness is the leading cause of death in Australia, with 2006 statistics showing that 140,000 people die every year from such diseases as diabetes, dementia and heart disease, and this number is also expected to increase.

So it’s vital for individuals, while they’re still well enough, to have conversations with their family about what they’d want if they became very ill or were dying.

It’s important because when an individual is no longer able to make decisions, often doctors turn to the next-of-kin or other family members for guidance about what to do, just as they did with Brian. And this is not just for guidance about a person’s official resuscitation status, such as “Not for Resuscitation”. Read more

 ***

Caring or curing: the importance of being honest

Ranjana Srivastava writes:

Mrs Jones is a delightful 75-year-old church volunteer diagnosed with cancer. Recently, she required surgery to remove fluid from her chest cavity. Much to her relief, she returned home after a prolonged recovery.

Some months later, the fluid in her chest was drained again but the progression of disease was obvious. Encouraged by her family, she decided to try chemotherapy. Her stated intent was that she wasn’t yet ready to die and would do anything possible to beat her cancer.

She felt buoyed by the first cycle of chemotherapy, but the second landed her in hospital – with all the side effects she had been warned to expect.

She left but spent the next two weeks in bed, weak and washed out. But her original intent remained strong and when it came time for the third cycle, she decided not to reveal just how ill she had been feeling. Read more

 ***

End of the care conveyor belt: death in intensive care units

Kenneth Hillman writes:

Intensive Care Units (ICU) were only just being established when I first became a specialist in 1981. They were small and intended for patients with life-threatening illnesses who could be supported for a few days to make a full recovery.

Admitted patients included sufferers of serious trauma or infections and those who had complex surgery, such as open-heart operations.

Thirty years later, the speciality has its own unique and legitimate place in medicine. Every large hospital has an ICU. I started with six beds in the early 1980s and have recently moved into a 60-bed unit.

The operating cost for each bed is over $1 million annually.

Their role has also changed. It’s now difficult to die peacefully in a hospital and an increasing number of our community will spend their last few days in an ICU. The change is not a conspiracy; it has just happened but it offers little benefit to anyone. Read more

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Deadly censorship games: keeping a tight lid on the euthanasia debate

Brian Martin writes:

There’s plenty of information available on how to kill yourself violently, so why does the Australian government so vigorously censor information on peaceful methods?

Voluntary euthanasia societies have long been pushing to legalise death with dignity. According to opinion polls, a strong majority of Australians support legalisation, yet Australian governments have been unreceptive. When the Northern Territory government legalised euthanasia in 1996, the federal parliament overruled the law less than a year later.

Philip Nitschke, despairing of the legal route, set up Exit International to enable people to learn how to obtain a peaceful death through their own initiative. Exit publications provide information about obtaining pentobarbital, commonly known as Nembutal, the drug of choice everywhere that death with dignity is legal.

The Australian government has responded with amazingly draconian censorship. No other government has taken such extreme measures to prevent access to information on peaceful death. Read more