Let’s be upfront with specific medical requests

Did you know only 14 per cent of Australians have advance care directives, or documents that outline their specific medical requests, should

Did you know only 14 per cent of Australians have advance care directives, or documents that outline their specific medical requests, should they become incapacitated?

Reports continually say roughly 70 per cent of Australian’s want to die at home or in a hospice, but because they aren’t speaking up about their wishes only a small proportion get the opportunity to do so.

According to the Grattan Institute, dying in Australia is more institutionalised than countries like New Zealand, the United States, Ireland and France. It also says that more than at any other time in history people are dying when they are old and more likely to know when they are going to die, which affords them plenty of opportunity to plan.

The Royal Australian College of GPs believes advance care planning should be incorporated into routine general practice. However, there are several issues surrounding why they are not more popular with patients.

The Grattan Institute says there is not enough public discussion, including education campaigns, about the limits of health care as death approaches.

Associate professor Bill Silvester, a physician and intensive care specialist at the Austin Hospital in Melbourne, says not identifying those people who are dying – and giving them treatment they would not want – results in money in the health system being wasted by providing care to people who never wanted it.

“That’s [advance care planning] about what would be an acceptable outcome for you,” Silvester said. “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?”

Another issue relates to the varying laws around Australia as to what constitutes an advance care plan.

Familial disagreement is also a major factor, but Silvester says guidelines are being created to demonstrate to doctors how conflicts can be resolved between patient and family, or the family and the doctor, and even between doctors.

Have you provided advance care directives? Do you know the medical wishes of your family or close friends in the event you have to make a decision on their behalf?

  1. Lynne Highfield  

    I believe an Advanced Care Directive to be a most important document yet almost all people simply refuse to discuss this subject let alone have one prepared for them. Why, when most of us will find ourselves in the position of perhaps needing one when it may well be too late? Could it be that the reason most people shy away from this type of discussion be because they secretly believe death and dying will not happen to them?

  2. Richard Barry  

    My mum had the exact opposite of “too much treatment”. THE DOCTORS WITHHELD LIFE-SAVING TREATMENT SIMPLY DUE TO HER AGE, A YOUNG 92!

    My mum died of severe sepsis, or septic shock at a Sydney public hospital last August.

    I have a very strong suspicion that she could have survived.

    I also have a very strong suspicion that age based withholding of proper treatment occurred. She was a young 92 and proper treatment and intesnive care was denied based purely on her age!.

    Apparently this age based withholding of treatment is quite common in Australian hospitals. To save money?

    Mum was very precious to me and I’m extremely upset that those doctors treated her as disposable!

    The doctor supposedly “caring” for her, a certain Dr B*****l, informed me that there was no hope, but on checking the literature on survival rates for septic shock, I found that the survival rate was about 50%, even for elderly patients.

    The associated surgeon was equally dismissive.

    QUOTE: “Age itself is an independent risk factor for death in patients with severe sepsis, however, many patients respond well to timely and appropriate interventions. The treatment should not be limited or deferred in elderly patients with severe sepsis only on the grounds of physician prejudice”

    At the time, I was in severe distress, and was not aware of what was happening.

    I actually queried the doctor as to why mum wasn’t in intensive care but did not receive an adequate reply.

    They just threw her into so-called “palliative care” without raising a finger to save her!!

    If only I knew then what I know now, I would have loudly protested this denial of treatment.

    The strange thing is that, she was receiving a dribble of antibiotics, and a modicum of pain killer. Why the antibiotics if there was supposedly no hope?????
    She should have been treated with AGGRESSIVE DOSES of antibiotocs and the source of the infection should have been cleared with laparoscopic peritoneal lavage.

    In her final hours she was in deep distress and apparently receiving no pain medication. I was shocked! I was too distressed and confused at the time to query this, and I am now suffering extreme guilt and sadness that I allowed this to happen without query.
    So much for “palliative care”!

    No wonder many people are scrambling for suicide pills to avoid this “palliative care”!!!!

    QUOTE: “Source control of infection and early aggressive dosing of appropriate antimicrobials are the two vital components of the management bundle of surviving sepsis guidelines”

    QUOTE: “Overall mortality from severe sepsis or septic shock ranges from 30% to 60% despite aggressive medical care
    There are high mortality rates of around 50%-60% in elderly patients with severe sepsis and septic shock
    Based on current evidence, the recommended approach includes careful selection and aggressive dosing of initial broad-spectrum antimicrobials”

    • Joy Dixon  

      I am sorry for your loss. I had a similar experience back in the early nineties in Sydney when my mother was about 80. She had a bleeding ulcer and the young doctor said she would gradually slip away as she had internal bleeding – when I asked why they weren’t giving her Losec (which I had the previous year for a stomach ulcer) they said “well at her age..” I turned into a screaming “fish monger’s wife” and insisted they give her Losec – of course within a week she came good and lived until 89. So yes ageism in health care is there and I suspect has it grounds in budgetary issues at some hospitals. I do believe the elderly tend to stay in hospital for longer terms and need more nursing care but what have they paid taxes for all their/our lives if not to be treated when we can be. Had my mother had acre directive in place at the time of course I would have honoured it, but she did not have one and we enjoyed another 5 plus years befor ethe slippery slope towards the end became obvious.

  3. I have had an Advanced Care Directive for some years, having seen my husband suffer terribly under “Palliative Care” – and I have my various Power of Attorneys appointed AND my funeral paid for. I appointed my nephews as my Attorneys, rather than have my children have to make any decisions, and frequently remind them of their responsibilities.

  4. Susan Bell  

    Advanced Care directives are essential. My children know what I want and will support me in any decisions.
    I have recently been diagnosed with diabetes, I have realised that I now have the ability to end my life when I want to. Instead of finding drugs to end my life I can have a party, eat and drink, not take my insulin and die in a peaceful coma. This has given me a great sense of freedom.

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