Choosing Where to Die !

Not surprisingly, a great many people would prefer to die in their own home but an ever increasing number end their life in a hospital bed.  There is a big difference between specialised palliative care to end a persons life with dignity and the reduction of pain and being admitted to a hospital where the impetus is directed at providing treatment and a cure for medical conditions.

The statistics are illuminating.  Dyeing is becoming increasingly institutionalised with death in hospitals increasing  from 62,000 to 77,369 between 2012/13 compared to 2016/17, while hospitalisation overall increased by just 17.6%. That represents an increase of 25.6%.

The problem seems to be that people have an aversion to talking about how their lives should end with their carers and their loved ones and the reasons are varied.   Surveys carried out by Palliative Care Australia show that 70% of people express a wish to die at home and yet only 15% do so.   The reasons people give for not discussing the manner of their death with carers ranges from " they were not sick ", 40 percent,  " They were too young ",  30 percent, " The subject makes them uncomfortable ", 24.5 per cent, " They didn't want to upset their loved ones ", 21.2 per cent.   The age of those surveyed was more than fifty-five.

Death is an inevitability  that should not be left to a last minute decision made by others.  Most people wish for a pain free death and that can usually be achieved with a little fore-planning.  What is essential is that the patients wishes should not be clouded in mystery.   If they are clearly known they have a very good chance of being achieved as requested.

Palliative care advocates have long called for more support for " at home " services to be provided.    The inability to manage a crisis at home is the main reason people are admitted to hospital in their last weeks according to the Grattan Institute's 2014 report.

What is clear is that Australia has a growing aged population and along with the march of chronic and incurable illnesses this form of death care in hospitals is adding to the health budget.  The average stay in hospital for palliative care patients is just under ten days and cost Medicare $6.1 million, up from $4.7 million in 2012/13.

There could be both a cost saving and the benefit of meeting patients wishes if the provision of in home services was expanded to relieve the pressure on loved ones and provide a pain free death that is the wish of so many people.   Perhaps the first requirement in bringing this to fruition is to remove the " unspeakable "  limit that prevents a rational discussion we must have with both loved ones and carers to enable our wishes to be fulfilled.

Patients wishes can not be met - if they are unknown  !