End-of-life care wishes clarified

SENIOR palliative care physician Paul Dunne says doctors have become more clever at delaying death.

He doesn't think this is always a good thing.

Dr Dunne, of Hobart, said medical advances and rising chronic disease made planning for end-of-life care more important than ever.

``In some cases, when people are incredibly ill, delaying their death may actually prolong their suffering and prolong their family's suffering,'' Dr Dunne said.

He said in cases where a patient's wishes around treatment and dying were unknown, the default was to do something to keep them alive. 

``So you end up maybe inflicting treatment on people that is unnecessary and unhelpful - and that in a way can cause people harm,'' Dr Dunne said.

University of Tasmania professor of nursing Isabelle Ellis said she hoped an electronic advance care planning model, developed with fellow researchers Linda Jaffray and Cathy Smith, would see doctors and patients broach the subject of death earlier.

Professor Ellis said the model would form part of the Australian Government's personally controlled eHealth record system after trials were finished early this year.

She said they had interviewed policy makers, clinicians, nurses, support organisations and older people to identify what they thought should be included in an electronic plan for end-of-life care, who it should be shared with and how it should be accessed.

``What we've found is that people don't want it available to any Joe Blogs, but they do want it available at the point of care to a registered health professional - so someone in the emergency department or the ambulance if they come to pick you up and you don't want a lot of resuscitation attempts made,'' Professor Ellis said.

``Because at the moment, someone rocks up at the hospital and their advanced care plan might be in a drawer at home. No one knows what's in it.

``People at the hospital are making the best choices they can for you, but it's not based on what you actually want.''

In an interview last month, state director of public health Roscoe Taylor said he wished he had more resources to drive a cultural change in the health system's approach to death.

``Sometimes it's best (for doctors) to have a discussion about the trajectory of a chronic disease quite a lot earlier in life, in those last years, before things get to an extreme point where someone's on a ventilator in intensive care,'' Dr Taylor said.

``It's not necessarily going to save money but it will create a better quality death for people.''

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