Say one thing, do another

There is a disconnect between what we say we would like to happen come those dying days (or weeks or months) and what actually eventuates.  In this ABC Health Report story, Dr Norman Swan relates the thinking of Dr Bill Silvester. An associate professor at the University of Melbourne, Silvester cites a number of studies and then opinions that the real job rests with the medical profession and politicians to engage with the community to change the status quo.

In: Why do so few people have a plan for the end of their life? (ABC RN Health Report,  22 March 2016) Swan says that, “Advance care directives, or documents that specify your medical requests if you become incapacitated, should be a slam dunk. GPs support them, patients want them, yet only 14 per cent of Australians have one. Why?”

 “It isn’t rocket science, it’s simply training [doctors] to sit down and talk to patients,” says Bill Silvester.  Dying at home, reports continually say, is what Australians want.

The Royal Australian College of GPs, no fringe organisation, believes advance care planning should be incorporated into routine general practice.  The consequences of getting end-of-life care wrong, Silvester notes, amount to more than just a missed opportunity.

‘We’re aware of many repeated occasions where people have undergone operations they never wanted—people with advanced dementia being fed through tubes, people with devastating strokes being kept alive.’

‘One per cent of the population are going to die every year. That’s hundreds of thousands of people.  ‘If we don’t identify those people are dying—and they receive treatment they wouldn’t want—we end up wasting money in the health system and delivering care that people never wanted in the first place.’

So if both doctors and patients support advance care directives, why aren’t they more popular?  Here is one line of thinking:  Partly, it’s a problem of messaging—as the frequently asked questions page of Advance Care Planning Australia hints, the issue can easily be mixed up with euthanasia.

Silvester admits the movement had a bumpy start in terms of messaging: ‘When advanced care planning was first developed, people thought you had to cover all the eventualities.’

He stresses the movement has now adopted an outcome-based approach.  ‘What would be an acceptable outcome for you. If you can feed yourself and you can relate to your family, is that enough?  ‘To put it the other way around, if you reach a point and you can’t walk or talk or feed yourself or interact with your family, what would you want at that time?’

Read the full report at:


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