Our report Dying Well argued that Australians don’t die the way they would like to. Most people would prefer to die at home with the support of family and friends and good quality support services. Most die in hospital or nursing homes. Often death is an isolating, depersonalised experience, in clinical settings visited by distraught and alienated family and friends. In many cases treatment continues when it is pointless. Not surprisingly, there is now strong support for people having the right to determine the circumstances of their own death, including active assistance when they choose it.
We place an unrealistic faith in health care to keep us alive – if only for a little longer. We don’t discuss, plan or prepare for death any more. Our report argued we should promote public discussion of dying; prompt conversations about our preferences for treatment and support when death is immanent, support advance care plans to make sure our preferences are implemented, and significantly increase support for people to die at home when that is their preference. These changes would be cost neutral.
Policy change and implementation to improve the quality of death in Australia is a challenge. Our report generated significant media and stakeholder attention. We presented at a number of forums, appeared before Federal and State parliamentary committees, participated in policy forums and workshops and briefed Federal and State Ministers and Shadow Ministers. Incremental changes have emerged, particularly in support for the implementation of advance care plans and greater support for home based palliative care. There is enormous interest but many issues, including the right to die when we choose to, remain unresolved.