Every Day Dying

Dying is a part of life, it happens every day.

Yet in Australia – as in many parts of the developed world – dying is a major source of anxiety and fear.

Sometimes those concerns are based on a loved one or friend who has experienced a painful death. But more often our fear of death is based on myth and misinformation.

St Vincent’s Health Australia has been providing healthcare for 180 years. We are a pioneer in providing care to individuals and their families as they approach the end of life.

It’s our experience that among the hundreds of deaths we witness every year in our palliative care services, the vast majority are peaceful: patients’ symptoms are well-managed and people are able to communicate their preferences and say their farewells.

Through Every Day Dying St Vincent’s Health Australia is sharing our expertise on end of life issues from the work we do in our services each and every day.

We believe death needs to be discussed respectfully but openly.

We want to inspire a community conversation about dying and the goals of health care when cure is no longer a possibility. We also want to encourage Australians to be clear about the type of care they would like at the end of their life and, importantly, what they don’t want.

We hope this website will help address some of the questions you may have about death and dying while providing you with links to useful information for further consideration.

Every Day Dying video project

As part of Every Day Dying we wanted to straighten out some of the misconceptions around reaching the end of life and about end of life care.

So we talked to patients with terminal illnesses, family members, and our staff about their experiences with death and dying.

We asked people who were approaching death about what was important to them and their families; and how they felt about palliative care.

And we asked our staff – many of whom care for people approaching the end of their lives every day – about the lessons they’ve learned, and their concerns around assisted suicide.

The Every Day Dying videos on these pages capture people at their most vulnerable and at their most courageous.

What is palliative care?

Palliative care improves the quality of life of patients and their families facing life-threatening illness. It prevents and relieves suffering through the early identification, assessment and treatment of pain and other symptoms, including physical, emotional, psychosocial and spiritual.

Palliative care also empowers patients to decide which treatments they would like to continue, and which have become too burdensome and should be stopped.

There is strong evidence on the benefits of palliative care in relieving symptoms and pain, but also improving quality of life, mood, satisfaction with care (for patients and their carers) and, in some cases, even survival.

And yet many Australians – including healthcare workers – are unclear about how palliative care works and are unaware of its benefits.

St Vincent’s Health Australia and end of life care

St Vincent’s Health established Australia’s first dedicated service for the terminally ill in Sydney almost 130 years ago. Our Caritas Christi Hospice in Melbourne was the first service of its type in Victoria, beginning in 1938. Our hospitals in Melbourne, Sydney and Brisbane currently provide the largest palliative care services in those cities.

At the heart of St Vincent’s Health Australia’s work rest two beliefs: that every person has an irreplaceable and unique value; and that people are vulnerable, particularly when they’re ill, and that it’s part of our mission to provide them the best possible care.

We tend to avoid discussions about death in our society, it makes us anxious. Death is commonly portrayed as either undignified or traumatic. But that’s not our experience.

We believe high quality palliative care is the best and most appropriate response to supporting people as they approach end of life.

Assisted suicide and euthanasia

Australia is currently facing a debate around the introduction of assisted suicide and euthanasia at end of life.

Physician-assisted suicide is where a doctor assists a patient to commit suicide by prescribing them lethal drugs to take at a time of their choosing. Euthanasia is where a doctor administers a lethal drug to a patient to end their life.

St Vincent’s Health Australia does not support assisted suicide and euthanasia.

We don’t believe assisting someone suicide, or to end their life intentionally, can ever be an expression of care for someone who is vulnerable – and there are fewer more vulnerable people than those who are terminally ill.

Evidence from around the world has also shown that legalisation of assisted suicide or euthanasia makes people living at the margins of our society even more at risk. Adverse effects on Indigenous people, people living with mental illness and disabilities, and the elderly – among others – have been observed in countries that have legalised these practices.

When St Vincent’s Health began more than 180 years ago, it was the sole mission of our founders to provide care to vulnerable and marginalised people. That same mission is what drives us today. We will not participate in any activity that compromises or risks care to vulnerable groups.

Assisted suicide's impact on palliative care

Australia has some very good palliative care services, but many people miss out because of inadequate resourcing. Estimates are that at least 100,000 Australians die each year without palliative care who could have benefited from its support. And a lack of quality services means only around 14% of Australians are supported to die at home.

In an environment where palliative care is already misunderstood and undervalued, the introduction of assisted suicide will further undermine its role.

For example, in the assisted suicide models being put forward in Australia a patient’s process towards terminating their life does not mandate the involvement of a palliative care specialist.

Under such a system, we believe some patients will suicide without fully understanding how palliative care could address their concerns, relieve suffering, and provide a dignified death where they would have control and their wishes respected.

We are also concerned that vulnerable people – such as Indigenous Australians or elderly people with limited English skills – may also no longer access palliative care, mistakenly fearing it will hasten their death, and will miss out on its benefits.

Assisted suicide - it's unworkable

One of the biggest dangers with the assisted suicide models put forward in Australia is that an individual can access a prescription of lethal drugs if two doctors judge them to have a terminal illness that will result in death within 12 months.

There is a wealth of international evidence to show that estimating the time a terminally ill patient has left to live is extremely difficult – even within their last weeks and months.

At one year, the margin for error significantly increases and most clinicians would find it an almost impossible assessment to make.

The risk is that people could elect, or worse still be encouraged, to end their life when they have more than a year to live; a decision that would rob them of the opportunity to have an extended period of improved quality of life with good quality palliative care and support.

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The Every Day Dying website and videos have been funded by St Vincent's Health Australia