By Amanda Vanstone
Life, in one sense, is the process of dying. We begin the inevitable march on the day we are born. Sadly, many do not get the chance to enjoy the normal lifespan. Accident, disease or war cut so many lives all too short. The rest have longer in which to experience all that is both bitter and sweet about life. There is, however, no escape.
Despite all the sophistication mankind has developed in the arts and the sciences we nonetheless seem unable to accept and manage with much elegance what is a given for every human being. Our inevitable fate. We should be delighted with medical advances that have resulted in longer healthy lifespans generally. Equally, the fact that we can now save from death so many, who injury and disease would otherwise have claimed prematurely, is a good thing.
Surely the mission of medical science is both to avoid premature death and to give quality of life to all of us but in particular those in the terminal stage of their life. Its mission is not to cheat an inevitable death.
The mother of a friend contracted a terminal type of bowel cancer when she was 71. She chose fairly aggressive treatment. Chemo first, then surgery. More than six operations later, some as a consequence of earlier surgery, she finally lost her battle. She spent most of her remaining five years in hospital.
Who knows whether we push the medical profession into letting us believe we can beat the odds or whether they become obsessed with seeing just how far all the knowledge, medication and equipment can take us. In any event, that’s what she chose.
The medical profession is too often put in a terrible position by patients and their families who don’t want to face the inevitable. They are asked to do everything that can be done. Done for what? To give anyone more quality years. Of course, that is what we would all support.
But there are limits. Limits to what it is fair to encourage someone to endure. ‘‘You can beat this’’ carries with it the notion of laziness and weakness if you don’t take up the fight. Sometimes encouraging someone to try to battle an inevitable death is just plain cruelty. Even torture.
There are financial limits as well. It is an awkward topic. One way to crystallise the issue is to ask yourself, irrespective of your age, what you think is reasonable to expect as free medication that would keep you going in a reasonable condition if you had a terminal diagnosis. Do you think $50,000 a year? What about $100,000? $500,000 or more? Would five years be fair? Maybe 10. Who knows. What we do know is we often want to spend this money on drugs or operations and procedures because we refuse to face the inevitable.
Not long ago I had a coffee with a trainee nurse who had just experienced her first patient death. I sympathised with how hard it must have been to be around the relatives because grief is so traumatic for everyone. To my surprise she told me it was not too bad for them, because they had expected it. Why? The patient was a 95-year-old having a hip replacement.
Senior medical professionals and scientists have called for a close look at how we treat those who are on an irretrievable path to the end stage of their life and in particular the very elderly in intensive care. It is certainly not just a cost issue. Nonetheless hundreds of millions, probably billions, are being spent for little value to the patient. That money could go both elsewhere in the health system and to reduce its budgetary impact.
Not just in general surgery but in intensive care we need to think carefully about what we do to ageing Australians. Doctors should not be put in the position of having to argue quality of life or cost issues with a family in shock at facing the mortality of a loved one. That is too harsh a burden.
Often these difficult decisions are left to relatives who are grief stricken and should not be asked to make these choices at such a difficult time. Relatives worry that they will look uncaring or perhaps like inheritance chasers if they advocate letting a loved one go. Some will feel intense guilt for not having done more in the earlier stages of a loved one’s life and seek to assuage this guilt by ‘‘standing up’’ for them now.
What might be the hardest and most caring thing to do is to put one’s own desire to be seen as nice or protective aside and actually stand up for what is in the dying person’s best interest. When that is to stop using them as a laboratory and letting them go with some grace, it will always be tough.
Far better we make these decisions ourselves when we are fit and well and rational. We can do this by making what is called an Advance Medical Directive. A senior medical professional recently strongly urged them to be mandatory for everyone over 73. He says if you don’t do it then you shouldn’t have a Medicare card. I am not sure how we can make people do this but I am sure we have to find a way.
Then we have to make sure the information is readily available to any hospital. We need to give doctors the information, the comfort and the backing of the law to say what we would want said if we were capable.
In many cases it will be something like this: ‘‘Your mum is in the very last stages of her life. Her wishes were very clear. She did not want prolonged, invasive treatment to extend her life for what would be a short period. She wants us to let her go gracefully. That’s what we are going to do.’’
Amanda Vanstone is a columnist with The Age and was a minister in the Howard government.