Ageing, death and dying have become the new pornography of the 21st Century. They are rarely talked about in polite circles and when they are, it’s in a distorted and denying way.

Neither peaceful, nor inexpensive

The genetic program for ageing is largely determined at the time of conception.

You can realise the best possible scenario for your body with things such as good diet and exercise but your body and the cells in it have been programmed to age and then die, no matter how many creams and supplements you use.

Dying may be a prolonged and unpleasant experience such as with some cancers or sudden as a result of, for example, a heart attack or catastrophic stroke.

When your time to die comes, the majority of Australians will be taken to a hospital. Ironically, most of us, when asked beforehand, would prefer to die at home, as long as we don’t suffer and are not an excessive burden on those caring for us.

How did this happen? It’s not a conspiracy, as very few gain from you dying in a hospital. You are probably in the majority of people who don’t want to spend their last few days there and they are already overcrowded with patients where modern medicine has something to offer.

The reason why we increasingly die in hospitals is complex.  People, quite understandably, become anxious when their loved ones become seriously ill. Despite discussions about how you want to die, the chances are that you and your carers will not understand whether or not something in the increasingly impressive array of modern medical drugs and procedures will work for you.

As a result, the ambulance is called. The paramedics and emergency doctors are there to resuscitate you, not to perform the last rites or to question your carers about whether this is what you would have wanted. You are on a conveyer belt, not of any one person’s making and on your way to my Intensive Care Unit.

Not only do lay people usually not understand what medicine can and can’t do; most of my medical colleagues also do not understand the limits of the increasing complexity of modern medicine. As a profession we have become fragmented.

On the one hand this has advantages. Being a specialist in one organ or area means you become good at it. When I had my operation I asked around to find out who was the best surgeon in this particular area, not someone who understood the chances of me surviving if serious complications set in.

However, it is increasingly common to be admitted to hospital when you are just old with multiple medical problems, simply as a result of things just wearing out. The problem now is that you will be seen by representatives of the various organ specialists, who will concentrate on their own area of expertise and miss the simple conclusion that the deteriorating organs all impact on each other, adding up to a situation far worse than the individual parts.

As a result, my role as an intensive care specialist is to increasingly diagnose dying, defined, as there is nothing more that even the most complex drugs and machines can offer.

There is often pressure at this point by my colleagues and the family to just give them a chance, albeit a small one. There are also my own pressures – fear of litigation; and not wanting to be seen as difficult by my colleagues or heartless by relatives.

And so, the chances of you spending the last few days of your life in an Intensive Care Unit is high; surrounded by strangers and supported by machines and drugs. In Australia, this is usually at no cost to you but at great cost to all of us.

My Intensive Care Unit will soon have 60 beds at a conservatively estimated operating cost of $1 million/annum/bed. Ironically, you may have been living on less than $200 a week for many years, supplementing your income by retrieving aluminium cans from garbage bins and then for your last few days of life you are given $3000 worth of care each day and you may not have even wanted it.

It’s worse, of course, in societies with private health, where there is a perverse incentive to keep you supported in the Intensive Care Unit as long as possible, even in the face of futility. As a result, many American families are bankrupted under the cruel illusion that they did everything for their loved one.

What can you do to have some control over your own dying? Discuss the issue openly and honestly with your friends and relatives so that they aren’t faced with the unfair burden of deciding how far things should go when the chances of you surviving are hopeless, or perhaps, even worse, when ‘survival’ means living out your life in a vegetative state in an institution.

Make your wishes clear in the form of an advance care directive. Don’t wait until you are old as tragedy can strike in young people as well as the elderly.

In a book I have recently written, I have tried to inform society about the way modern medicine operates, not using facts and figures but stories, composites, as a result of working as an intensive care specialist for nearly 30 years: stories about courageous people; sad stories; stories about the dignity of dying; and, of course, stories about the unexpected and of miracles.

VITAL SIGNS: Stories from Intensive Care, by Professor Ken Hillman is published by UNSW Press. RRP $32.95

7 comments

Show oldest | newest first

    • Liz says:

      06:50am | 09/12/09

      You move in different circles from the rest of us.In the real world,where I live death,dying and all in between are open subjects.I recently was witness to the marvellous dying of an elderly man who was cared for tenderly and lovingly by his son and family at home where he died in his own bed.

    • James says:

      07:46am | 09/12/09

      er.. in the ‘real world’, people usually don’t die in their own beds. dude’s an intensive care specialist. please don’t claim to speak for the ‘rest of us’. straight up, people don’t make plans for the end and this he’s written an interesting article about that. ymmv

    • hoofman says:

      07:48am | 09/12/09

      I see Tony Abbott proudly promoted one of his ‘senior’ party members, Bronwyn Bishop, to be the party spokesperson (or would Bronnie prefer oldfashioned ‘spokesman’?) on seniors. Maybe, given the advanced average age of his front bench, he could have appointed a spokesman for the dying. The cadaverous Phillip Ruddock would have been a pea for that job.

    • T.Chong says:

      08:34am | 09/12/09

      hoofman re Bronny B. I reckon shes hanging around on the remote chance that the Libs win, and then she would be appointed Govenor General.
      She is ye olde fashioned and pompous enough to desire that post.
      BB funniest moment was mid 1980s:  put on footy boots and jumper and kicked at a ball. “Bronny for PM” was funny,almost as funny as “Joh for PM” campaign not long after.
      Those conservatives,: gotta Luv ‘em.

    • Zeta says:

      01:29pm | 09/12/09

      I can’t see any dignity in dying in an intensive care ward. I’m sure guys like Ken Hillman make sure it’s as comfortable as possible, and that you don’t suffer… but it’s such an ignoble end. Are our lives meant to be comfortable and without suffering? And if not, why then do we make our deaths like that?

      Being kept alive for no other reason than it’s politically correct, by a well meaning but otherwise cowardly family who can’t handle the great mysteries of death. That’s a tragedy. We’re not meant to live forever, and we’re certainly not meant to spend our waning years in terror of life-ending falls, sickness, and infections.

      Is there anyway to avoid being sent to hospital in your old age once you start dying? How exactly does one withdraw consent to medical care like that?

    • SteveB says:

      03:31pm | 09/12/09

      Zeta: depending on which state you live in, you may be able to lodge a “living will” which can outline circumstances under which you do not wish to receive medical treatment that prolongs life, but still receive palliative treatment such as pain relief.

      Hopefully we shall soon see states passing Voluntary Euthanasia laws which will allow people even more control over their end of life treatment.

    • stephen says:

      03:42pm | 09/12/09

      I wanna live as long as i can. This life ain’t a dress-rehearsal. This is it I reckon.
      Though there is somethin’ goin’ on.  (I don’t reckon I’ll live longer when I find out.)

 

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