Avoiding the conversation can multiply problems tenfold at a later date.
* Dr Rudd is a representative of the Australian Medical Association Queensland
It was his tears that wrenched at me. Great sobs of despair for a woman denied the chance to live out her last days as she wanted to. But he wasn’t crying for a family member, or even a friend. He was her Doctor.
Situations like this are happening across Queensland. My colleagues tell me about the heartbreaking frustration that is arising because too few patients make plans with their loved ones about the sort of end-of-life care they want.
The AMA Queensland is calling for a large-scale campaign to make sure that people have an Advance Care Plan in place which sets out the care they want in their final days.
This will be one of several critical health policies we will raise during the election campaign, although we’ve no desire to play politics with such a sensitive issue.
We also believe there needs to be an increase in health funding to ensure that more of those who wish to die at home can do so.
Nearly three-quarters of people express a wish to die at home, yet most will die in hospitals.
The most recent figures show that barely a third of Australians have discussed preferences for end-of-life care with their families. The fact is that our collective failure to have this uncomfortable conversation in life means that our loved ones might have a less comfortable death.
When you create an Advance Care Plan (ACP), which some call a ‘living will’, you set out clearly the sort of care you want at the end of your life. Without this, doctors may end up providing you with treatments you might not want, which could be painful, or create more stress for you and your family.
Your doctor might not know who you wish to make decisions on your behalf, or whether you’d prefer to be at home or in hospital. Or your loved ones might make decisions you don’t agree with.
Sometimes these plans aren’t just about medical decisions; it might be about a final opportunity to visit your favourite spot, or see that friend you lost contact with. It might be that you’d cherish a few more days at home, than in a sterile hospital bed.
Doctors are desperate to have access to this sort of information so they can provide you with the care you want. A state-wide registry of Advance Care Plans and other directives which could be attached to patient records would mean any doctor could access your wishes should the worst happen.
A substantial increase in funding for palliative care should be used for on-the-ground nursing staff to care for people at home when they are dying.
A state-wide awareness campaign would include improving community and health care education about terminal illness, aged care and the options for palliative care during the last months of life.
The Australian Medical Association Queensland hopes to see funding for doctor training to enable them to be more ‘conversation ready’ and to ensure all those in nursing homes or palliative care have a plan which can be easily accessed by their doctor.
Our ageing population and increased life expectancy means end-of-life care is an increasing priority. But this isn’t just an issue for older people, any of us could be struck by accident or disease that reduces our decision-making capacity at any age.
Only by shining a light on this crucial issue can we ensure those uncomfortable conversations start happening more often, for everyone’s sake.