The difference between dying in a hospital and being able to die in your own home surrounded by friends and family could be a matter of ‘speaking up’. A recent report compiled by the Grattan Institute, Dying well, found that around 70 per cent of Australians would prefer to die at home, yet only 14 per cent currently do. That’s less than half of people who choose to – and do – die at home in New Zealand, France, USA and Korea, as well as several other countries.
Australian policies and medical attitudes are partly to blame, as too is the current lack of support for suitable advanced home care programs. However, Dying well points out that many people who are dying don’t speak up about how they want to die and, therefore, don’t live out the last of their days as they would prefer.
In the last 100 years, the average lifespan has increased by 30 per cent, with about two-thirds of Australians dying between the ages of 75 and 95. Nowadays, the issue of dying is generally more predictable. Doctors are usually accurate to within one month in estimating when a particular person is likely to die.
People want to be able to choose and control the place in which health care is provided during their last days. Often people don’t die at home because there is insufficient support services or because they haven’t articulated their preferred choices through detailed discussion and prior planning with family and clinicians.
It seems too, that enabling twice the amount of the current rate of home deaths could be effectively cost-neutral, because an increase in home-care services would reduce the demand on the hospital system.
Australians are lucky to have a good public health-care system, but it is becoming increasingly clear that we do not provide adequate support for home and palliative care. Dying well raises awareness of the need for the types of end-of-life services that Australians really want.
People want to die with dignity. End-of-life care has to change in order to improve the quality of dying and to meet the wishes of how Australians want to die.
If you’re interested, you can view the report.
Or you can read the press release.
Opinion: Difficult but necessary
According to the report, Dying well, failure to talk about and plan for death is one of the main obstacles to improving the quality of dying. Having to talk about death is not an easy thing – it’s no secret that it is one of the most difficult things in life with which to deal. Starting the ‘dying’ dialogue sooner than later, is paramount for those wishing to die in a comfortable environment surrounded by those they love, instead of with someone in a white coat and scrubs.
I had a health scare recently and had to face the possibility that I could have died. It’s even difficult to say ‘there was a chance I could die’ in this article, because death scares me so much. I mean it really scares me. I know I am not alone.
What started out as harmless banter, turned into a conversation with my partner about how I’d like to die. It started with a joke about something to do with a Viking funeral, but it eventually got serious. We discussed things such as resuscitation, life-support and funerals. We even talked funeral songs. We talked about who we wanted around us and who we did not. By the end of the night we had a decent understanding of what each of us wanted in our time of dying. It was a weird discussion. It was also strangely liberating.
I understand that my thoughts and ideas about my ‘end of days’ may change over time, but if something happened to either of us tomorrow, I feel like I could act with some authority on how to handle this phase. I suppose what I’m saying is, maybe talking and planning for death shouldn’t have to be so scary.
Talking about dying is no easy task. It’s usually quite difficult for the person facing his or her imminent demise to talk about it with anyone. It can be just as difficult for the family and friends of the dying to accept the fact that someone they love will die.
My girlfriend’s mother, who is in her 70s now, has tried many times to talk to us about what to do on the occasion of her dying. The conversation usually starts with her telling her children to put sticky dots on all the things they would like handed down to them after she dies. When the subject comes up, the children all say that the last thing they want to think about is her dying. They say they’ll deal with it when the time comes. They don’t want to think about it. She is the brave one in bringing the subject up. After reading this report, I understand now, that dealing with it later will be too late – and it’s unfair on her for us to ignore her wish to talk about dying. It is important to her and needs to be discussed so that she can rest easy knowing that all will be go according to her wishes.
Death is a tough subject and we all have our preferences and opinions on how we want to die. It may sound cliché, but death is something we all have in common. Contrary to our predominately ‘western ways’, it should be something we can talk about.
Have you had this type of discussion with your family or doctor? Have you had experience with home care? How do you feel about talking about death? What are your thoughts?