Ken Hillman puts the case for people centred health care

“Hardly a day goes by when I don’t look at someone on a life-support machine and think, ‘Don’t ever let this happen to me.’”

According to Ken Hillman, professor of Intensive Care at the University of NSW, this is one more good reason Why you need to talk about death today  (Emma Reynolds, news.com.au May 25, 2016).

“Be honest about what medicine can do and can’t do,” he says.

Intensive care beds are filling up with patients near the end of life.  At a cost of $4,000 per person per day, it is clearly unsustainable.  Not only financially, but also socially.  The quality of life is not there.

In a previous article: Dying Safely (Oxford Journals 13 August 2010 339-340), Ken Hillman writes that patients who are “ … seriously ill but dying in a predictable and inevitable way, where further active intervention would be futile,” could benefit from what is known as rapid response systems (RRSs).  Having said that he has identified that: “Unfortunately many patients are still inappropriately admitted to the ICU (Intensive Care Unit) for end-of-life care at great cost and the problem will only increase as our society ages.”

In yet another story, this time: When the end is nigh, it’s best to avoid hospital (SMH 31.10.2009) professor Hillman says: “My grandfather died at home in 1959, managed by a wonderful GP. Most of my friends’ grandfathers died at home.”

But then medicine got in the way: “The health system is geared to actively treating patients, not in recognizing the dying,” he says.

“Once death was treated as a relatively normal and inevitable experience.  It is now a highly medicalised ritual.”

The crux of the situation we are faced with is contained in this few lines:

“It is difficult to get off this conveyor belt. The reasons why are many and complex. Unreal expectations of what modern medicine can offer, reinforced by everyday stories of the latest medical miracle; the inability of politicians and funding bodies to rationally limit resources for end-of-life care without accusations of neglect or even murder; the difficulty of progressing this discussion in a society with such diverse opinions; the increasing specialisation of medicine; the practical fact that it is easier for busy clinicians to continue active treatment than to undertake the difficult and time-consuming business of talking to relatives and patients about dying.”

Vital Signs, by Ken Hillman, is a collection of stories about the experiences of intensive care patients, their families and carers. It is about ordinary people facing terrible tragedies and the ways they cope with them. Up to 70% of people now die in acute hospitals surrounded by well-meaning strangers inflicting all that medicine has to offer.  There are others ways.  This book helps clarify our thinking as we search for the way that is right for us. See if a copy is at your local library.

In an appearance on TEDxSydney 2016 Ken Hillman talks about his experiences and how we might get beyond our death denying society to a point where doctors, families and the community work together to find a solution that offers both quality of life and a safe way to die.  Go to https://tedxsydney.com/talk/were-doing-dying-all-wrong-ken-hillman/  or the TEDxSydney mobile app.

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