Let's talk about dying - Peter Saul

Summary

In this thought-provoking talk, the speaker addresses the inevitability of death in the 21st century and the challenges it presents. Highlighting the shift in causes of death and the limitations of intensive care, the speaker emphasizes the importance of open dialogue about end-of-life preferences. Through personal stories and statistics, they advocate for reclaiming control over the dying process, suggesting both individual and political action to ensure a more humane and dignified end to life.

Takeaways

• 💡 The inevitability of death in the 21st century is a truth that may upset some, but it's a reality that everyone must face.
• 😮 The belief in personal immortality is common, with surveys showing one in eight people think they won't die, but this is a misconception.
• 🧠 The process of dying begins early, with millions of cells dying daily, including brain cells, highlighting that the end of life is a gradual process.
• 🚑 Intensive care has seen great success in reducing death rates, especially for males in Australia, but this has also led to a reliance on technology.
• 🔄 There's a shift in how people die, with diseases of old age being less responsive to intensive care treatments than in the past.
• 👴 The aging population is leading to more deaths from organ failure and frailty, which are less treatable with current medical interventions.
• 🏥 The lack of dialogue about end-of-life preferences is a significant issue, with few having plans in place for serious illness or death.
• 🤔 The importance of discussing end-of-life preferences with family and healthcare providers is emphasized to ensure wishes are respected.
• 🏠 A cultural issue exists around discussing death, which hinders the implementation of patient-centered care plans.
• 🌱 The idea of 'respecting patient choices' was well-received when introduced, but the practice did not continue without ongoing support.
• 🛤️ The speaker advocates for a cultural and political shift to reclaim the process of dying from the medicalized model, focusing on patient autonomy.

Q & A

What quote does the speaker begin with and why is it relevant to the topic?

The speaker begins with a quote from Gloria Steinem: 'The truth will set you free, but first it will piss you off.' It is relevant because the speaker is about to discuss the uncomfortable yet inevitable truth about death and how it is often avoided or misunderstood in contemporary society.

What is the speaker's profession and how does it relate to the topic of dying in the 21st century?

The speaker works in intensive care and has witnessed the evolution of death and dying due to advances in medical technology. Their profession is directly related to the topic as they deal with life and death situations regularly and have insights into how death is managed in modern healthcare.

How does the speaker describe the process of dying in the 21st century as it relates to intensive care?

The speaker describes the process of dying in the 21st century as a 'train wreck' for most people, with intensive care often being a place where people end up due to the lack of other options, despite the fact that it may not be the most desirable or appropriate place for them to die.

What is the significance of the speaker's encounter with Jim Smith in the narrative?

The encounter with Jim Smith is significant because it made the speaker realize the lack of dialogue and planning around end-of-life care. Jim's situation highlighted the absence of conversations about preferences for care when faced with severe illness or death.

What did the speaker and their colleague Lisa Shaw find when they reviewed medical records regarding end-of-life conversations?

They found that there was no record of any doctor or patient initiating a conversation about goals, treatments, or outcomes in the event of unsuccessful treatment leading to death. This indicated a significant gap in communication about end-of-life care.

What is the 'Respecting Patient Choices' initiative mentioned in the script and what was its outcome?

The 'Respecting Patient Choices' initiative was a program introduced at John Hunter Hospital to train staff to discuss end-of-life preferences with patients. The outcome was positive, with 98% of people believing it should be standard practice, and it led to patients' wishes being fulfilled. However, once the funding ended, the practice stopped, indicating the cultural resistance to discussing death.

What are the four ways to die mentioned in the script and which one is the 'biggest growth industry'?

The four ways to die mentioned are sudden death, the dying process of those with terminal illness, increasing organ failure, and the dwindling of capacity with increasing frailty. The 'biggest growth industry' is the dwindling of capacity with increasing frailty, which is now the main cause of death for many people.

What is the speaker's 'small idea' for improving the situation of dying in the 21st century?

The speaker's 'small idea' is for individuals to engage more in conversations about end-of-life preferences with their elders and loved ones. This includes asking who they would want to speak for them if they became too sick to speak for themselves and ensuring that person is aware of their wishes.

What is the speaker's 'big idea' and how does it relate to the cultural issue of death?

The speaker's 'big idea' is to get political and reclaim the process of dying from the medicalized model that currently dominates it. This involves advocating for more control over the dying process, not necessarily through euthanasia, but by addressing the cultural issues that prevent open discussions about death and end-of-life preferences.

What does the speaker mean when they say they are an opponent of euthanasia and why?

The speaker opposes euthanasia because they believe it is a sideshow and not the main issue. They argue that the focus should be on giving people control over their dying process, which would reduce the demand for euthanasia. The speaker is more concerned with the experiences of the majority who do not choose euthanasia.

How does the speaker conclude their talk and what message do they want to leave with the audience?

The speaker concludes by emphasizing the importance of recognizing that every individual matters until the last moment of their life, as quoted from Dame Cicely Saunders, the founder of the hospice movement. The message is to carry forward the idea of respecting patient choices and having open conversations about death and dying.