Fighting to the end
Rod Mackenzie has planned his death. Now he is among the local experts leading confronting conversations about how we should be dealing with death
ROD Mackenzie has planned his death. Sitting in a green sofa chair by the floor-to-ceiling window of his study during a rare sun-drenched lapse in an otherwise typically grey August afternoon, Mr Mackenzie describes some of the ways he plans on dying.
“I’ve gone as far as I can in refusing medical treatments in case I have to be on life support,” the 84-year-old former parliamentarian says. “I don’t want to be resuscitated if I have a heart attack — that’s all written down. Don’t resuscitate me.”
He also has a plan in case he is diagnosed with Alzheimer’s, the disease that stole his mother away from him two years before it finally killed her.
“I’ve got a declaration — it’s not legally binding, but it is up to a point — if I’m diagnosed with Alzheimer’s and it gets to a stage where I’ve got to go into a nursing home or a hospital, then I don’t want to be fed. I can refuse medical treatment and I can refuse food.
“What that means is I’ll just be given water and probably take about a fortnight to get weaker and weaker, and sleep longer and longer, and one day I just won’t wake up.”
Mr Mackenzie isn’t thinking about death because he’s sick. Rather, he is one of a growing number of experts who believe we need to get better at planning how we would like to spend our final days.
Geelong hospital intensive care unit director Dr Neil Orford is one expert who fears we have become so good at prolonging life that we are now “doing death badly”.
Dr Orford is well-acquainted with death.
Each year, he personally deals with about 200 families experiencing a death, and more often than not, they aren’t ready for it.
“It just seems like in a whole lot of ways we’re not getting it right,” Dr Orford says.
“Death is inevitable, but we just keep doing things to you to keep you alive and we don’t talk to you about the fact that your death is impending. And we don’t give you choices about what you could do.
“In those last couple of months, weeks and days of life there is a point where we should switch from doing everything possible to keep you alive to talking about what you want those last months to look like.”
There’s a sad irony to Dr Orford’s ongoing push to get us talking about death.
In 2015 his father Bill died in what Dr Orford describes as a fog of sedation and painkillers.
Bill had progressive dementia and physical deterioration and was hospitalised after a backyard fall that left him with bleeding on the brain, and his family with fears of a further decline in quality of life.
Getting good end-of-life care from the hospital — which Dr Orford prefers not to name — was a struggle.
“Rather than spending the last week of his life sitting in his bed talking to him and just reflecting on his life, I spent the whole time fighting with the hospital to get them to recognise that we didn’t want him to go to intensive care … we just wanted to keep him comfortable,” he says.
“It was pretty confronting and ironic that on one hand I work for a hospital that is doing a whole lot of work to be better at end-of-life care, but I can’t get it for my own Dad.”
Dr Orford’s work in promoting better end-of-life care has included being a part of Barwon Health’s 2014 launch of My Values, a free service advising people how to plan and communicate their wishes about the medical treatment they want in the later stages of life.
Mr Mackenzie and many of his neighbours in the Geelong Grove Retirement Village in Marshall took up a chance to use the My Values service after a recent Barwon Health visit.
“It’s an interesting thing. I don’t know if 80 is a turning point, but for most people when they get to 80 death is talked about quite openly,” Mr McKenzie says.
“There’s nothing you can do about it. It’s inevitable. So, that doesn’t worry people, old people talk about it.
“The thing that worries them is the manner of death. The fear, if there is any fear, is the fear of the manner.”
While it isn’t assured Mr Mackenzie will have any control in the manner of his death, it would be fitting if he did. As president of the Legislative Council in 1988, he cast the deciding vote that passed the Medical Treatment Bill, which outlined the current refusal of treatment legislation.
For the past 29 years, the Bill, which became an Act when passed, has given all Victorians the ability to take a small measure of control over their death.
While the impermanence of life is a difficult subject for most people to accept, both Mr Mackenzie and Dr Orford believe it is a discussion that needs to be had more often.
“I’ve gone as far as I can in refusing medical treatments in case I have to be on life support. I don’t want to be resuscitated if I have a heart attack — that’s all written down. Don’t resuscitate me.” ROD MACKENZIE