Happy ending
WHEN is it time to let someone go?
This is a dilemma many families face. It can be an impossible decision for the family, and a difficult thing for doctors to suggest.
Modern medicine is shifting discussions about death and dying from conversations that are too hard to talk about and had too late to discussions that are empowering and occur before we approach our end of life.
When we have conversations about end of life, few people want invasive medical interventions that simply prolong death.
We find that most important to a person at the end of life is their dignity, comfort and dying naturally, with their family present.
Barwon Health is championing discussions around end of life care, person-centred care and shared-decision making, through programs such as Advance Care Planning, MyValues and iValidate becoming known across Australia and internationally.
Our programs challenge the concept of saving a life at all costs, no matter the chances of recovery, and focuses on a person’s values, what’s important in their life, and what medical interventions they would want and wouldn’t want to have.
We have some way to go to improve conversations around end of life treatment choices but in other countries it is much worse. Patients and families rarely express any opinion about limits and doctors never stop, even where treatment is clearly futile.
Recently, I visited Thailand with fellow University Hospital Geelong Intensive Care Specialist Dr Nima Kakho to support and educate senior clinicians about how to raise end of life discussions with families.
In Thailand it is common to continue to support patients indefinitely even though it is clear that they can never recover.
This causes their intensive care units to be full of those who can’t get better while others, who could benefit, can’t get in.
Our task was to introduce Thai clinicians to a new philosophy about intensive care treatment: stopping when it doesn’t work and sharing the skill of how to have conversations with families.
With some fantastic help from Geelong’s Thai community, and using the fabulous skills of the Barwon Health media unit, we created a video to illustrate the fundamental steps involved in suggesting that treatment has failed and that “keeping on” might not be kind, or in the best interest of the patient.
While we were there, in order to understand how Thai doctors felt about end of life care and interventions, we asked for a show of hands.
The first proposition was that they felt reassured that their medical treatment would never be stopped — no-one put their hand up.
Next we asked whether going on and on was required because it was a cultural necessity in Thailand — again, no-one put their hand up.
Finally, we asked if they were terrified about the prospect of indefinite life support treatment … and everyone put their hand up.
We were left in no doubt that the audience did recognise the problem.
This week, I will return to Thailand to teach another group and I look forward to speaking with them and again putting the video to good use.
This won’t be a short or simple transformation, it will take years — but it has started.
The problem is everywhere, and it is remarkable that Barwon Health is recognised as a lead educator in end of life communication and patient-centred care.
With our emphasis on Advance Care Planning, we are finding that more and more families faced with a medical crisis know what is important to their loved one and have a good idea of what they would want.
This is another area where Barwon Health is demonstrating leadership.
Anybody can talk to their GP about creating an Advance Care Plan, which will outline how far you would like your treatment to go.
People can also visit the MyValues website (www.myvalue.org.au), which will help you work through any issues. Alternatively you may contact the Barwon Health Advance Care Planning service 1300 715 673.
Associate Prof Charlie Corke is a senior intensive care specialist at Barwon Health, Victorian Voluntary Assisted Dying Board deputy chair of the and author of the book Letting Go.