In: When the end is nigh, it’s best to avoid hospital, Ken Hillman (SMH October 31, 2009) is speaking from years of experience and first hand knowledge.

Many of us will spend the last few days of life in an intensive care unit. For many, it will be a painful and futile experience, causing unnecessary suffering for the patient and loved ones.

Once death was treated as a relatively normal and inevitable experience. It is now a highly medicalised ritual. Now, when someone who is old and near the end of their life suddenly or even gradually deteriorates, the ambulance is called. The paramedics cannot be discretionary, even when it is against the wishes of the patient. The role of emergency rooms is to resuscitate and save lives, and package the patient for admission to hospital, whether active treatment is appropriate or not.

It is difficult to get off this conveyor belt. The reasons why are many and complex. Unreal expectations of what modern medicine can offer, reinforced by everyday stories of the latest medical miracle; the inability of politicians and funding bodies to rationally limit resources for end-of-life care without accusations of neglect or even murder; the difficulty of progressing this discussion in a society with such diverse opinions; the increasing specialisation of medicine; the practical fact that it is easier for busy clinicians to continue active treatment than to undertake the difficult and time-consuming business of talking to relatives and patients about dying.

All of this is exacerbated by a health system driven by fees for services, with little incentive to embark on the difficult business of managing dying. There are the ethical issues and the fear of litigation from a predatory legal system.

All these factors mean it is increasingly likely that a patient will not be plucked off the conveyer belt until everything medical has been administered and the last few minutes of life squeezed out.

There are limited provisions for rescuing these people and providing more appropriate care. My specialty of intensive care often acts as a surrogate end-of-life service at unsustainable cost to society.

NOTE: Ken Hillman is professor of intensive care at the University of NSW. This is an extract from his book, Vital Signs. His more recent book is titled: A Good Life To The End.

Read the full article here: When the end is nigh