EUTHANASIA is not the elephant in the room, but a “mouse in the room looking down a microscope”, a Hunter intensive care specialist says.
Dr Peter Saul said the assisted-dying debate had come to overshadow the broader issue of end-of-life care – a topic that would, eventually, affect everyone.
Yet Hunter hospitals were “badly under-resourced” to provide adequate end-of-life and palliative care to the thousands of patients who need it each year, he said.
“Assisted dying is a tiny minority issue,” he said.
“The universal thing is people want control. People have grown up nowadays expecting to have some input into what happens to them.
“The extreme end of that is where they demand to be killed, which is assisted dying. But we’re not talking about that. We are just talking about any ordinary person wanting to have some input into decisions made at the end of their lives. And it’s harder than it sounds.”
Dr Saul is a senior intensive care specialist for Hunter New England Health.
He said healthcare professionals were trained to focus on finding a cure, or making a patient better, and they were often not having a conversation about death with patients until it was too late.
It had become common for intensive care units to look after 80 year old people with conditions such as pneumonia, and now most Australians were dying in acute care hospitals.
“Once every three days in the last year of your life you are in contact with a pharmacist, GP, physio, dietitian.
“Many times you end up in the emergency department,” Dr Saul said.
“Towards the end of your life that becomes burdensome, and at some point we have to stop.”
But Dr Saul said many people did not realise they were dying.
He said when they looked at data from John Hunter Hospital and Calvary Mater it showed few patients were being referred to palliative care.
“One in 10 had no mention in their notes that they were dying at all at the time of death,” he said.
“Out of 100 people, none were coded as palliative at the time of death, and only 1 in 10 was having a pain score done. These are not very encouraging numbers.
“But acute care hospitals weren’t set up as places for people to die, so the fact they have become the standard place to die has caught everybody on the hop.”
He encouraged people to have an advanced care plan, and to have conversations with their families about their wishes.
“How much would you be prepared to go through to survive that little bit longer?,” Dr Saul said.
“In the event you couldn’t speak for yourself, and couldn’t make your own decisions, who would you like to speak for you?
“When you get to your late 80s, you’re different from when you’re in your 30s. You may not want so much - you may be more prepared to say, ‘I don’t want to suffer, I just want to be allowed to go’.
“If you can talk to your family about what’s important to you, it really helps them to make decisions when doctors ask about treatments.”