How more and more of us are dying in the 21st century…and how doctors choose to die

We live, on average, around 30 years longer than we did 100 years ago.  Isn’t that an astonishing sentence. I’m gonna have to read that again.

This means there’s been a big shift in the way people die.  How we die has changed beyond all recognition in a single generation.  Despite the fact this has happened to one of my neighbours this week, sudden death is rare now.  And, though it sounds odd, terminal illness affects more younger people now.  Only one in ten of people over 80 years old will, for example, die of cancer.  The ‘growth industry’ of death is now in these two areas: organ failure,  and dwindling capacity, increasing fraility.  One undeniable fact of increased longevity is, at risk of saying the obvious, more old age.

Peter Saul unpacks all this in a TED talk called ‘Dying in 21st century Australia, a new experience for all of us’.  He’s a Senior Intensivist who’s been deeply involved in the dying process of over 4,000 patients in the past 35 years.  As a result of his experience he revolutionised end of life planning in an Australian hospital – until the funding ran out.  It boils down to the fact that on a personal level we need to talk with our elders, and to each other, about what we want and make choices about how we would prefer to die.  

About one in ten people will die in an Intensive Care Unit (ICU) in Australia.  In America, it’s one in five.  (In Miami it’s three out of five!)  I don’t know what the stats are for the UK but I imagine the general momentum is the same.  “The stress created in families by dying is enormous,” Saul says, “and you get seven times as much stress by dying in Intensive Care as dying anywhere else.  Dying in Intensive Care is not your top option if you’ve got a choice.”

As I write, one of my oldest friends is moving his father from an IC Unit in a hospital into a hospice, so this feels very much a live issue, so to speak.  The point is, of course, is that it’s a live issue for increasing numbers of people all the time.  At the political level, we need a revolution…

To listen to all of Peter Saul’s 14 minute talk click here:   

Meanwhile, some American research published by the Guardian last year reveals that doctors don’t die like the rest of us.

What’s unusual about them is not how much treatment they get compared to others, but how little.  They know enough about modern medicine to know its limits.  Most medical professionals have seen what’s called ‘futile care’ performed on people ie when doctors bring the cutting edge of technology to bear on a greviously ill person near the end of life.  Doctors know enough about death to know what all people fear most: dying in pain and dying alone.  They’ve talked with their families and made their choices clear.

The message is – if you can, find a way to die in peace at home, and that pain can be managed better than ever now.

Read the full article here

and the reaction from British medics here