so with that in mind i 'm going to set about trying to do those things here and talk about dying in the
surveys but
so there you go that 's the truth no doubt that will piss you off and now let 's see whether we can set you free i don 't promise anything now as you heard in the intro i work in intensive care
and i think i 've kind of lived through the heyday of intensive care it 's been a ride man this has been fantastic we have machines that go ping there 's many of them up there and we have some wizard technology which i think has worked really well
and over the course of the time i 've worked in intensive care the death rate for males in australia has halved and intensive care has had something to do with that certainly a lot of the technologies that we use have got something to do with that
so we have had tremendous success and we kind of got caught up in our own success quite a bit and we started using expressions like lifesaving i really apologize to everybody for doing that because obviously we don 't what we do is prolong people 's lives and delay death
and redirect death but we can 't strictlyspeaking save lives on any sort of permanent basis and what 's really happened over the period of time that i 've been working in intensive care
is that the people whose lives we started saving back in the seventy s eighty s and ninety s are now coming to die in the twenty first century of diseases that we no longer have the answers to in quite the way we did then
and he looked like this i was called down to the ward to see him his is the little hand i was called down to the ward to see him by a respiratory physician he said look there 's a guy down here he 's got pneumonia and he looks like he needs intensive care his daughter 's here and she wants everything possible to be done
which is a familiar phrase to us so i go down to the ward and see jim and his skin his translucent like this you can see his bones through the skin he 's very very thin and he is indeed very sick with pneumonia and he 's too sick to talk to me so i talk to his daughter kathleen and i say to her
did you and jim ever talk about what you would want done
and i got talking to her and after a while she said to me you know we always thought there 'd be time
jim was ninety four
so a group of us started doing survey work and we looked at four and a half thousand nursing home residents in newcastle in the newcastle area and discovered that only one in a hundred of them had a plan about what to do when their hearts stopped beating
one in a hundred and only one in five hundred of them had plan about what to do if they became seriously ill
now i work in acute care this is john hunter hospital and i thought surely we do better than that
so a colleague of mine from nursing called lisa shaw and i went through hundreds and hundreds of sets of notes in the medical records department looking at whether there was any sign at all that anybody had had any conversation about what might happen to them if the treatment they were receiving was unsuccessful to the point that they would die
and we didn 't find a single record of any preference about goals treatments or outcomes from any of the sets of notes initiated by a doctor or by a patient
so we started to realize that we had a problem and the problem is more serious because of this
what we know is that obviously we are all going to die but how we die is actually really important obviously not just to us but also to how that
features in the lives of all the people who live on afterwards how we die lives on in the minds of everybody who survives us
and the stress created in families by dying is enormous and in fact you get seven times as much stress by dying in intensive care as by dying just about anywhere else so dying in intensive care is not your top option if you 've got a choice
and if that wasn 't bad enough of course all of this is rapidly progressing towards the fact that many of you in fact about one in ten of you at this point will die in intensive care in the u s it 's one in five in miami it 's three out of five people die in intensive care so this is the sort of momentum that we 've got at the moment
the reason why this is all happening is due to this and i do have to take you through what this is about these are the four ways to go so one of these will happen to all of us
the ones you may know most about are the ones that are becoming increasingly of historical interest sudden death
it 's quite likely in an audience this size this won 't happen to anybody here
sudden death has become very rare the death of little nell and cordelia and all that sort of stuff just doesn 't happen anymore the dying process of those with terminalillness that we 've just seen occurs to younger people by the time you 've reached eighty this is unlikely to happen to you only one in ten people who are over eighty will die of cancer
the big growth industry are these
what you die of is increasing organ failure with your respiratory cardiac renal whatever organs packing up each of these would be an admission to an acute care hospital at the end of which or at some point during which somebody says enough is enough and we stop
and this one 's the biggest growth industry of all and at least six out of ten of the people in this room will die in this form
which is the dwindling of
capacity with increasing frailty and frailty 's an inevitable part of aging and increasing frailty is in fact the main thing that people die of now and the last few years or the last year of your life is spent with a great deal of disability unfortunately enjoying it
i feel such a cassandra here
what we did anyway look what we did we didn 't just take this lying down at john hunter hospital and elsewhere we 've started a whole series of projects to try and look about whether we could in fact involve people much more in the way that things happen to them
but we realized of course that we are dealing with cultural issues and this is i love this klimt painting because the more you look at it the more you kind of get the whole issue that 's going on here which is clearly the separation of death from the living and the fear like if you actually look there 's one woman there
who has her eyes open she 's the one he 's looking at
she looks terrified
so with loads of funding from the federal government and the local health service we introduced a thing at john hunter called respecting patient choices
we trained hundreds of people to go to the wards and talk to people about the fact that they would die and what would they prefer under those circumstances they loved it the families and the patients they loved it ninety eight percent of people really thought this just should have been normal practice and that this is how things should work
and when they expressed wishes all of those wishes came true as it were we were able to make that happen for them but then when the funding ran out we went back to look six months later and everybody had stopped again
and nobody was having these conversations anymore so that was really kind of heartbreaking for us because we thought this was going to really take off
the cultural issue had reasserted itself
so here 's the pitch i think it 's important that we don 't just get on this freeway to icu without thinking hard about whether or not that 's where we all want to end up particularly as we become older and increasingly frail and icu has less and less and less to offer us there has to be a little side road
off there for people who don 't want to go on that track
and i have one small idea and
one big idea about what could happen and this is the small idea the small idea is let 's all of us engage more with this in the way that jason has illustrated why can 't we have these kinds of conversations with our own elders and people who might be approaching this
that 's a really important question to ask people because giving people the control over who that is produces an amazingoutcome the second thing you can say is have you spoken to that person about the things that are important to you so that we 've got a better idea of what it is we can do so that 's the little idea
the big idea i think is more political i think we have to get onto this i suggested we should have occupy death
i don 't think euthanasia matters i actually think that
you can have physician assisted suicide you take a poisonous dose of stuff only half a percent of people ever do that i 'm more interested in what happens to the ninety nine point five percent of people who don 't want to do that i think most people don 't want to be dead but i do think most people want to have some control over how their dying process proceeds
so i 'm an opponent of euthanasia but i do think we have to give people back some control it deprives euthanasia of its oxygen supply
i think we should be looking at stopping the want for euthanasia not for making it illegal or legal or worrying about it at all
this is a quote from dame cicely saunders whom i met when i was a medical student she founded the hospice movement and she said you matter because you are and you matter to the last moment of your life and i firmly believe that that 's the message that we have to carry forward
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