Everybody wants to live a good life, but Dr Shaun Rudd — the new President of the Australian Medical Association QLD — says it’s just as important to have a good death.
Dr Rudd, a Hervey Bay GP, believes too much of our health budget is spent on futile end-of-life care for patients who would be better off being allowed to die at home.
“I think one of the most important things is that you’re with your loved ones when you die, and that you’re in a comfortable place, which is usually home,” Dr Rudd says. “That’s the most comfortable place that all of us have. No matter where we go, or which hospital we end up in, the one place we all want to be is home. I think being at home with your loved ones, and being looked after so that you’re comfortable, so that you’re not in pain and not in discomfort, and you can quietly pass away… that, to me, would be a good death.
“When you ask people, the huge majority want to die at home. But the reality is a huge majority still die in hospital.”
Dr Rudd says there are two reasons why patients at the ends of their lives are subjected to futile treatment in hospital, rather than being allowed to pass away in peace at home. “One reason is that it’s easier, even though it’s more expensive, to let people die in hospital. There aren’t the resources required to organise palliative care at home. People need to understand… in the past, palliative care has always been thought of as something that happens for people with cancer, but the reality is that palliative care is something that happens for people with chronic illnesses as well.
“Chronic chest diseases, chronic heart diseases, any sort of chronic condition that puts people on the road to death… you need to organise it so they can die at home. You usually have plenty of time! It’s not like these things appear out of the blue! You’ve got plenty of time to organise these things. But at the end of the day, the resources have to be there.”
And the second reason? “People in the medical profession feel that they have to do everything they can,” Dr Rudd says, “otherwise somebody’s going to come knocking on the door and say, ‘Why didn’t you do that?’ In other words, a fear of litigation comes into it somewhere along the line. Which is very unfortunate, because the reality is, it’s clearly stated that you should not provide futile treatment to patients, even if their relatives demand it.
“I really believe it’s about the conversation that you have with relatives and with patients. The worst thing you can say to somebody is, ‘Should we do everything for your dad?’ Well, what’s your answer going to be? Of course it’s going to be yes. But if they said, ‘Your dad’s dying, we can keep him nice and comfortable and he can enjoy the last bit of time he has, rather than us doing all sorts of terrible things to him that won’t achieve anything’… well, of course you’ll say, ‘Yes, that’s what I want you to do’.”
Dr Rudd believes all patients should have the chance to sign an advance care directive (or living will), but he doesn’t believe in euthanasia. “Not at all, not at all, not at all,” he says emphatically. “No, this isn’t about rushing people to their deaths, or giving them an opportunity to die earlier. It’s a matter of looking after these people in a caring home environment so they can die there.
“The last place you want to be when you’re dying is amongst machines that go ‘ping’ and all that sort of stuff. You also want to be away from people who have this idea in their head that they have to not let you die, when in fact, you’re at a stage where that’s what you want to do, and that’s the next phase of your life, if I can put it that way. You’re coming up to a point in your life where you want to die, and you want to do it in a comfortable place with your loved ones, and you don’t want lots of medical interference.
“The medical fraternity needs to lead this discussion, so everybody’s comfortable with it. We’re the experts in these things, we know what treatment is futile, and we have to be open and honest about that. We have to advocate for patients to be allowed to die at home, if it’s at all possible.”
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