How can we ensure Australians experience a ‘better’ death?

| December 9, 2013

People are living longer, and consequently the practice of medicine and the way we live and die has changed. Dr Zoe Keon-Cohen is part of a panel addressing the sensitive topic of end of life planning.

Current practices in end of life medical care require major change to ensure more Australians experience ‘better’ deaths, according to a panel of medical, ethical and legal experts. End of life care and the Australian aging population has gained increasing attention of late.

A roundtable report has come about from a meeting sponsored jointly by Monash University School of Public Health and Preventive Medicine, the Melbourne University School of Population and Global Health and the Australian Institute for Health Research last February. The forum was organised to address the issues created by an aging population, changing demographic of medicine and rapidly advanced technologies.

The meeting identified the need for improvement in end of life care and the associated barriers and drivers for change and was summarised into a blueprint paper and my final White paper. The one-day forum included examples of common clinical cases in the hospital sector, and demonstrations of the need for change. This was followed by expert presentations and robust debate to analyse the issues, root causes, and provide potential solutions.

“People are living longer and consequently the practice of medicine and the way we live and die has changed,” Professor McNeil said. “Therapeutic and technical advances have improved and extended lives of many Australians, but at a cost – a new older generation of people is living with more complex disease and gradual decline in quality of life.

“This creates new challenges for medical practice in particular, balancing the imperative to ‘cure’ with the personal, social and financial burden it can create. End-of-life care implies an awareness of this balance.”

More than 52 per cent of Australians now die in hospital, despite the fact that most would prefer to die at home. In 2011, more than 146,000 people died in hospital in Australia. “As the population ages, we are seeing an increasing amount of surgery that is of marginal benefit. We now know that a high percentage of surgical patients over 80 years of age will have complications following surgical procedures resulting in extended hospital stay and increased mortality.”

The major focus for change recommended was education, with other key issues discussed including clinical behaviour, clinical leadership, practitioner confidence, and hospital procedures.

“The benefits of improving the system are multiple – extending to patients and families where there will be improved quality of life-before-death, medical teams and carers to alleviate psychological, moral and emotional distress and conflict, and an improved allocation of resources within the health care system more broadly,” Professor McNeil said.

Particular attention was paid to the need to make specific recommendations that were realistic and could be developed with broad support. We also wish to ensure that we avoid misinterpretation regarding this sensitive area by the community and wish to create a movement of positive engagement with patients and families about their values, lives and how they wish to live them including towards caring for them around end of life.

Key conclusions of the report are several: These include

  • increased community awareness and acceptance of the need for end-of-life planning, especially in the context of chronic and serious illness
  • promotion of more open discussion between families and clinicians to allocate medical power of attorney and ensure relatives are made aware of a person’s best interests and wishes in advance
  • improved communication, data storage and communication of these patient’s wishes, especially when emergencies such as hospital-MET calls arise
  • better teaching about end-of-life issues in the training of all health professionals
  • greater leadership and involvement of senior clinicians in end of life care decision and support for junior doctors after hours
  • alignment of legislation amongst the states
  • improved resources for research and implementation of advance care planning in different specific patient populations.

Much care was taken to address this sensitive topic, and the motivation for the report is a recommendation to improve medical care at a stressful and difficult time.

We hope to engage the new federal government and all state governments to achieve the panel’s stated desired outcomes for change and sustainable improvement.



  1. Hani.Montan


    December 19, 2013 at 10:27 pm

    Better Death

    I’m intrigued by Dr Zoe Keon-Cohen’s blog describing the gathering of an expert panel to address the sensitive topic of end-of – life planning. I assume the key points discussed were: the patients’ advance planning for death (Advance Care Directive) and the palliative care. My assumption is based on the stated fact that Dr Zoe Keon-Cohen’s interest is in resuscitation guidelines and advance care planning. From the list of the panel’s discussions, I feel this group of highly intelligent people—intentionally or unintentionally—have avoided the real humanitarian issue of ending the life of a suffering patient peacefully and with dignity, especially the terminally-ill who is suffering unbearable pain. Currently, some doctors are using extraordinary means to prolong the life of the dying patient, which is not necessarily in the best interest of the patient or their devoted family. In contradiction, however, other doctors—in consultation with the next of kin or the legal guardian—employ passive euthanasia by disconnecting life-support systems to allow the patient to die. Expensive modern technologies, such as artificial breathing apparatus, can now keep the patient in a coma for months and years; occupying hospital beds that could be used by other patients with better chances for survival and recovery. Fortunately, the group recognises the challenges of modern medical practice and the need for balancing the imperative to “cure” with the personal, social and financial burden it can create. To overcome all anomalies and to clarify doctors' responsibilities and patients' rights, it has become necessary to legalise the practice of accepting patients’ wishes and clarify the laws of passive euthanasia to allow doctors—in consultation with the next of kin or the legal guardian—to objectively decide upon a course of action that is in the best interest of the patient and the health system. I don’t understand why so many doctors hide their real feeling and avoid an open discussion on the desperate need by desperate patient for assisted suicide as an essential element of the medical practice. Is it because of religious belief or the imposition of religious dogmas by vocal ultraconservative religious leaders? Or is it because the AMA that is often controlled by right wing conservative groups, which dictates the social and political agenda? How can any scientifically minded doctors justify the religious definitions of death as, “when the soul leaves the body” that is based on metaphysical philosophy, which is scientifically unsustainable? How can doctors abandon their patients in the dying stage by discarding them to palliative care establishments when they have exhausted all possible intensive and invasive treatments? This is when in the majority of cases, to control the dying patient’s unbearable pain is by giving him or her heavy doses of painkillers and continuous injection of morphine. Often, heavy doses of painkillers and morphine are insufficient to eliminate the pain or restore the patient’s desire for terminating his or her life serenely and with dignity. The practice is called palliative sedation by making the patient comatose, which leads to shortening life and eventual death. It’s a prolonged form of euthanasia. How can doctors discuss end-of-life medical care for Australians to experience “better” deaths without including the subject of assisted suicide? I feel some doctors tend to hide behind emotive slogan of “doctors are healers and not killers.” And the religious ones tend to hide behind another emotive slogan of “God gives life and takes it away.” Please have compassion!

    • Davekyn

      August 31, 2016 at 6:35 am

      Well Said Hani Montan

      Thank You for clarifying much of what was missing from the above Blog Description. Thank You.