Look, I had second thoughts really about whether I could talk to about this to such a vital in a live audience is you guys.
But then I remember the quote from Gloria Steinem, which guys The truth will set you free.
But first, it will piss you off.
So eso with that in mind, I'm gonna set about trying to do those things here and talk about dying in the 21st century.
Now that the first thing that will piss you off undoubtedly, is that all of us are in fact going to die in the 21st century, there will be no exceptions to that.
There are apparently about one in eight of you who think you're immortal on surveys.
But unfortunately, it isn't.
This isn't gonna happen.
Um, while I give this talk in the next 10 minutes, 100 million of my cells will die.
And over the course of today, 2000 of my brain cells will die and never come back.
So you could argue that the dying process starts pretty early in the piece.
Anyway, the second thing I want to say about dying in the 21st century part is gonna happen to everybody is it's shaping up to be a bit of a train wreck for most of us, unless we do something to try and reclaim this process from the rather inexorable trajectory that is currently on.
So there you go.
That's the truth.
No doubt that will piss you off.
Now let's see whether we can set you free out.
I don't promise anything.
Now, as you heard in the intro.
I work in intensive care and I think I've kind of lived through the heyday of intensive care has been a ride man, this has been fantastic.
We have machines that go ping.
There's many of them up there.
Um, and we have some wizard technology which I think has worked really well, and over the course of the time, I've worked in intensive care.
The death rate for males in Australia has hard and intensive Cares had something to do with that.
Certainly a lot of the technologies that we use have got something to do with that.
So we have had tremendous success and we we kind of got caught up in our own success quite a bit, and we started using expressions like life saving.
I really apologized everybody for doing that because obviously we don't.
What we do is prolong people's lives and delay death on redirect death.
But we we can't strictly speaking, save lives on any sort of permanent basis.
And what's really happened over the period of time that I've been working intensive care is that the people whose lives we started saving back in the seventies eighties and nineties are now coming to die in the 21st century off diseases that we no longer have the answers to in quite the way we did then.
So what's happening now is there's been a big shift in the way that people die on most of what they're dying off now isn't is amenable.
Toe what we can do as what it used to be like when I was doing this in the eighties and nineties.
So we kind of we kind of got a bit caught up with this, and we haven't really squared with you guys about what's really happening now, and it's about time we did.
I kind of woke up to this bit in the late nineties when I met this guy.
This guy is called Jim, Jim Smith and he looked like this.
I was called down to the ward to see him.
His is the little hand.
I was called on the world to see him by a respiratory position.
He said, Look, there's a guy down here.
He's got pneumonia and he looks like he needs intensive care.
His daughter's here and she wants everything possible to be done, which is a familiar fries to to us.
So I go down to the warden, see Jim and his skin is translucent like this.
You can see his bones from the skin is very, very thin.
And he is indeed very, very sick with pneumonia, and he's too sick to talk to me.
So I talked to his daughter Kathleen, and I say to her, Did you and Jim ever talk about what you would want done if he ended up in this kind of situation?
And she looked at me, said No, of course not, OK, it's like this study, Um, and I got talking to her, and after a while she said to me, You know, we always thought that be time.
Jim was 94 and I realized that something wasn't happening here.
There wasn't this dialogue going on that I imagined was happening.
So a group of it started doing survey work.
And we looked at 4.5 1000 nursing home residents in Newcastle in the Newcastle area and discovered that only one in 100 of them had a plan about what to do when their heart stops beating one in 100 on anyone in 500 off them had a plan about what to do if they became seriously ill.
I realize, of course, this dialogue is Jeff definitely not occurring in the public at large.
Why work in acute care?
This is John Hunter Hospital, I thought.
Surely we we do better than than that.
So a colleague of mine from nursing court, Lisa Shore and I went through hundreds and hundreds of sets of notes in the medical records department, looking at whether there was any sign at all that anybody had.
Hennie had any conversation about what might happen to them if the treatment they were receiving was unsuccessful to the point that they would die.
And we didn't find a single record off any preference about gold's treatments or outcomes from any of the sets of notes initiated by a doctor or by a patient.
So we started to realize that we had a problem and the problem is more serious because of this.
What we know is that obviously we are all going to die.
But how we die is actually really important, obviously not just to us, but also to how that features in the lives of all the people who live on after.
It's how we die, lives on in the minds of everybody who survives us.
And the stress created in families by dying is enormous.
And you felt you get seven times as much stress by dying in intensive care as by dying just about anywhere else.
Dying in intensive care is not your top option if if you've got a choice.
Andi, if that wasn't bad enough, of course, all of this is rapidly progressing towards the fact that many of you, in fact, about one in 10 of you at this point will die in intensive care.
In the US it's one in five in Miami, it's three out of five people die in intensive care, so this is the sort of momentum that we've got at the moment.
The reason why this is all happening is due to this, and I do have to take you through what this is about.
These are the four ways to go so one of these will happen to all of us.
The ones you may know most about are the ones that are becoming increasingly of historical interest.
It's quite likely in an audience this size this won't happen to anybody here.
Sudden death has become very rare.
The death of Little Nell and core Delia and all that sort of stuff just doesn't happen anymore.
The dying process of those with terminal illness that we've just seen occurs to younger people.
By the time you reached 80 this is unlikely to happen to you.
Only one in 10 people who are over 80 will die of cancer.
The big growth industry of these what you die off is increasing organ failure with your respiratory, cardiac, renal, whatever organs packing up each of these would be an admission to an acute care hospital at the end of which or some point during which somebody says enough is enough and we stop and this one's the biggest growth industry of all Onda.
At least six out of 10 of the people in this room will die.
This form, which is the dwindling off capacity with increasing frailty and frailties an inevitable part of aging and increasing frailty is in fact, the main thing that people die off now, on the last few years or last year of your life spent with a great deal of disability, unfortunately enjoying it so far.
So I had this field such a I feel such a Cassandra here.
What can I say this positive?
What's positive is that this is happening at very great age.
Now we are We are all most of us living to reach this point.
Historically, we didn't do that.
This is what happens to you when you live.
To be a great age on.
Unfortunately, increasing longevity does mean more old age, not more youth.
And I'm sorry to say that, um, what we did anyway, Look what we did.
We didn't just take this lying down at John Hunter Hospital announced where we've started a whole series of projects to try and look about whether we could in fact involve people much more in the way that in the way that things happen to them.
But we realize, of course, that we are dealing with cultural issues on this is I love this clip painting because the more you look at it, the more you kind of get the whole issue that's going on here, which is clearly the death, the separation of death from the living on the fear.
If you actually look, there's one woman there who has her eyes open.
She's the one he's looking at, and he's the one he's coming for.
Can you see that?
She looks terrifying.
It's amazing picture.
We had a major cultural issue.
Clearly, people didn't want us to talk about death or we thought that.
So, with loads of funding from the federal government and the local health service, we introduce the thing that John Hunter called respecting patient choices.
We trained hundreds of people to go to the wards and talk to people about the fact that they would die, and what would they prefer under those circumstances?
They loved it.
The families of the patients, they loved it.
9 98% of people really thought this just should be normal practice and that this is how things should work on the When they expressed wishes, all of those wishes came true.
As it were, we were able to make that happen for them.
But then when the funding run out, we went back to look.
Six months later on, everybody had stopped again.
Andi, nobody was having these conversations anymore.
So that was really kind of heartbreaking for us because we thought this was going to really take off.
The cultural issue had reasserted itself.
So here's the pitch.
I think it's important that we don't just get on this freeway toe.
I see you without thinking hard about whether or not that's where we're all want to end up, particularly has become older and increasingly frail on I see you has less unless, unless to offer us.
That has to be a little sign road off there for people who don't want to go on that track.
And I have one small idea.
Andi, One big idea about what could happen, and this is a small idea.
The small idea is, let's all of us engage with more.
With this in the way that Jason is illustrated, Why can't we have these kinds of conversations with our own elders on people who might be approaching this, that there are a couple of things you can do?
One of them is You can just ask this simple question.
This this question never fails.
In the event that you became too sick to speak for yourself, who would you like to speak for you?
That's a really important question to ask people, because giving people the control over who that is produces an amazing outcome.
The second thing you can say is, Have you spoken to that person about the things that are important to you so that we can?
I got a better idea of what it is we can do, so that's a little idea.
The big idea, I think, is more political.
I think we have to get onto this.
I suggested we should have occupied death, my wife said.
I said, We're here, right?
Sittings in the mortuary?
Yeah, sure, So that one didn't really run, but I did.
I was very struck by this.
Now I'm in aging hippies.
I don't know.
I don't look like that anymore, but I had to to my kids were born at home in the in the eighties, when home birth was a big thing and then we baby boomers are used to taking charge of the situation.
So if you just replace all these all these words of birth, I like peace, love, natural death as an option.
I do think we have to get political and start to reclaim this process from the medicalize model in which it's going.
Now listen, that sounds like a pitch for euthanasia.
I want to make it absolutely crystal clear to you all.
I hate euthanasia.
I think it's a sideshow.
I don't think euthanasia matters.
I actually think that that in country, in places like Oregon, where you can have a physician assisted suicide, you taken a poisonous dose of stuff.
Only half a percent of people ever do that.
I'm more interesting what happens to the 99.5% of people who don't want to do that?
I think most people don't want to be dead, but I do think most people want to have some control over how they're dying.
Process proceeds, so I'm a point of euthanasia, but I do think we have to give people back some control.
It's deprives euthanasia of its oxygen supply.
I think we should be looking at stopping the want for euthanasia, not for making it illegal or legal or worrying about it at all.
This is a quote from from Dame Cicely Saunders, whom I met when I was a medical student.
She she founded the hospice movement and she says you matter because you are and you matter to the last moment of your life.
And I firmly believe that that's the message that we have to carry forward.