The time has come to talk about dying

In their editorial, intensive care physician William Silvester and respiratory physician Karen Detering from the Respecting Patient Choices Program said advance care planning was beginning to be recognised as a pivotal part of end-of-life care.

“Our common law duty of care as doctors is to always act in the patient’s best interests”, they said in their editorial.

“One of the most practical ways to put this into action is to regularly ask ourselves, ‘Am I caring for this patient or family the way that I would want myself or my family to be cared for, by taking the time to identify their personal, spiritual or religious views and take these into account when I am making decisions?’” they said.

The authors said it was important for doctors to ensure patients’ consent to treatment was fully informed, by understanding their goals and values and by identifying their wishes regarding treatment if they became seriously ill and could no longer decide or communicate what they wanted.

Doctors needed to talk to the family when a patient was no longer competent to make decisions and to know ahead of time what a person would want, they said.

“More than half of us are not in a position to express these preferences at the end of life”, the authors said.

In a separate MJA article, palliative care doctors Brian Le and Michael Chapman outlined a case which raised the question of “whether a person has the capacity to make decisions for him- or herself” regarding end-of-life care.

The issue was “likely to become an increasing problem, as palliative care services care for an ageing population, with a significant comorbid burden, who are more at risk of diminished capacity due to the prevalence of illnesses such as dementia”, they said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

The statements or opinions that are expressed in the MJA  reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.

CONTACTS:              Ms Julie-Anne Davies                                                 0413 583 919
                               National Communications Director, Austin Hospital
                               On behalf of Associate Professor William Silvester

                               Ms Nicky Webster                                                      03 9342 7796 / 0408 503 180
                               Director, Public Affairs and Media, Royal Melbourne Hospital.
                               On behalf of Dr Brian Le