End-of-life care ‘needs a rethink’

Wednesday, December 14, 2016

‘End-of-life care in Australia needs a rethink in order to improve it’, Australian Healthcare and Hospitals Association Chief Executive Alison Verhoeven said today.

Ms Verhoeven was responding to today’s release of an Improving end-of-life care in Australia issues brief by the Association’s Deeble Institute for Health Policy Research, and the release of an AHHA position statement on the same topic.

‘End-of-life care should relieve suffering, preserve dignity, be accessible and enable people to die in a place of their choice.

‘In practice, this is not happening—for example, most people, when asked, say they would prefer to die at home, but only 14% achieve this.

‘We are facing increasing demand for end-of-life care due to an ageing population, increasing rates of chronic disease, and the availability of aggressive therapies for the frail elderly that often extend life but can also cause harm. Around 154,000 Australians die each year, with two-thirds dying between the ages of 75 and 95.

‘Taken together, all these factors mean that the annual number of deaths will double in Australia in the next 25 years, and people will die more frequently with multiple chronic medical conditions, which in turn prolongs the end-of-life period while also making time of death more predictable.

‘As a nation we have been slow to adapt to these changes. Most people have clear preferences for the care they want at the end of their life, but rarely do they have open conversations that lead to effective end-of-life care plans for them.

‘On the healthcare side, it becomes difficult for medical professionals to know how far to pursue treatment and to understand at what point treatment becomes futile. The pressure to prolong life is enormous, and there is strong evidence that medical staff continue to provide futile care—indeed it is counter-intuitive for doctors not to do so.’

‘The decision to withhold care or death-delaying therapies affects the person involved, families, health professionals, the health system and the broader community. It’s complicated, and it all happens at a highly emotional time, which is why we need to get the nation’s house in order, to deal with this period of life appropriately, with dignity and with compassion.

‘We see end-of-life care training for health professionals, supported by properly and systematically documented end-of-life wishes, and improved capacity to identify people who will die in the short to medium terms as part of the solution. We also need a better shared understanding of when care becomes futile.

‘There should also be a nationally consistent legislative framework to support end-of-life decision-making, enhanced linkage between health IT systems and the My Health Record to alert providers to people’s advance care planning documents, improved access to end-of-life care in multiple care settings, and more public awareness programs that support end-of-life conversations’, Ms Verhoeven said.

The Australian Healthcare and Hospitals Association is the national peak body for public and not-for-profit hospitals, Primary Health Networks, community and primary healthcare services, and advocates for universal, high quality and affordable healthcare to benefit the whole community.

For more information on AHHA, visit http://ahha.asn.au.

Media enquiries: Alison Verhoeven, Chief Executive, Australian Healthcare and Hospitals Association, 0403 282 501