Four Corners: A Good Death

Four Corners returns tomorrow with a report by Deb Masters who spent 10 weeks over Christmas at the Sacred Heart Palliative Care Unit, part of St Vincent’s public hospital in Darlinghurst.

Masters followed four Australians all diagnosed with a terminal illness, as well as the people that are determined to give them a good death – doctors, nurses, partners, children.

Seven out of ten Australians die what might be called an “expected death”. In many cases doctors can tell patients roughly how long they have to live. However, only a few take advantage of those warnings. Instead they prefer to believe that somehow modern medicine will save them. Now a small group of doctors and nurses are warning that our obsession with curing illness is leaving patients poorly cared for and unprepared for death.

In a nondescript building just a short walk from the centre of Sydney the Sacred Heart Palliative Care Centre is housed. There, a small group of health care professionals are devoting their lives to death.

The people they treat are perhaps the bravest in our community. All diagnosed with a terminal illness, they have accepted their fate but are determined to make the best of the time they have left – in effect, to die “a good death”.

Three months ago four of those people made a courageous decision. They agreed to let Four Corners spend time with them as they came to terms with their diagnosis and entered the final stages of their life. Their reasons for doing this varied but, in essence, they all hoped that by documenting their last days of life and their death they could help others deal with the experience.

If you talk to any of the people at Sacred Heart they will quickly tell you that they believe too many people run away from the prospect of death, and for that they pay a terrible price.

For palliative care patient Darryl Calver the acceptance of his situation meant he could agree to a treatment that would stabilise his condition and give him time to sort out family relationships that had frayed at the edges.

Doctors and nurses there have an additional message: they say too many doctors are reluctant to acknowledge that they don’t have a cure. As a result, they give patients false hope or, worse, leave them in limbo. As the Director of Sacred Heart, Dr Richard Chye says:

“I think a lot of doctors find it very hard to say you are dying… it’s not easy for doctors to actually say no, I can’t give you any more treatment. I tell my patients I know I cannot cure you but I can make you feel better. I will walk with you.”

A major part of making terminally ill patients feel better is pain management. Balancing the need to control pain while allowing the patient to remain active and alert is a job that takes real expertise. Unfortunately not everyone has the training to do it.

Professor Ken Hillman, from the University of New South Wales, told Four Corners that the failure to accept the limitations of modern medicine means too many patients end up in acute care hospital wards. Those wards are not designed to provide the environment or the treatment that allows for “a good death”.

“Approximately 70% of Australians die in acute hospitals… Getting sick at home, put in an ambulance, coming into the hospital … It’s the process which has happened subtly. And its happened without any discussion with our society. It’s just what we do. And we do it for what we consider are in the best interests of patients. We want to look after them. We want to cure them. And in doing so we’ve set up a situation where it’s difficult to die peacefully.”

Sandy Riches couldn’t agree more. She has breast cancer that has spread to different parts of her body. She knows she may not have long to live but she is also relieved that by facing her own mortality and being treated at a palliative care centre she will have a place where she feels comfortable to die.

If there is one final message that comes from the terminally ill and those who care for them it is this: palliative care must be accepted as an integral part of medicine and resourced appropriately. If that is done, more people might be able to come to terms with the prospect of death and be able to make the most of the time they have left.

“A Good Death” airs Monday 8th February at 8.30pm on ABC1 and is repeated on February 9th at 11.35pm. It will also be available online at abc.net.au/4corners and on iView