TEDxNewy 2011: Peter Saul discusses Dying in 21st century Australia | Newcastle Herald | August 3, 2024 - video Dailymotion

Newcastle Herald

Video: TEDx Newy / Youtube

Transcript

00:00Figaro, Figaro, Figaro, Figaro!

00:13Look, I had second thoughts really about whether I could talk about this

00:17to such a vital and alive audience as you guys.

00:20But then I remembered the quote from Gloria Steinem, which goes,

00:24The truth will set you free, but first it will piss you off.

00:32So with that in mind, I'm going to set about trying to do those things here

00:36and talk about dying in the 21st century.

00:38Now, the first thing that will piss you off, undoubtedly,

00:40is that all of us are, in fact, going to die in the 21st century.

00:44There will be no exceptions to that.

00:46There are apparently about one in eight of you who think you're immortal on surveys,

00:51but unfortunately this isn't going to happen.

00:58While I give this talk, in the next ten minutes,

01:00100 million of my cells will die.

01:03And over the course of today, 2,000 of my brain cells will die and never come back.

01:08So you could argue that the dying process starts pretty early in the piece.

01:13Anyway, the second thing I want to say about dying in the 21st century,

01:15apart from it's going to happen to everybody,

01:17is it's shaping up to be a bit of a train wreck for most of us,

01:22unless we do something to try and reclaim this process

01:25from the rather inexorable trajectory that it's currently on.

01:28So there you go. That's the truth.

01:30No doubt that will piss you off.

01:31Now let's see whether we can set you free.

01:33I don't promise anything.

01:35Now, as you heard in the intro, I work in intensive care.

01:38And I think I've kind of lived through the heyday of intensive care.

01:41This has been a ride, man. This has been fantastic.

01:43We have machines that go ping.

01:45There's many of them up there.

01:47And we have some wizard technology, which I think has worked really well.

01:51And over the course of the time I've worked in intensive care,

01:54the death rate for males in Australia has halved.

01:56And intensive care has had something to do with that.

01:58Certainly a lot of the technologies that we use have got something to do with that.

02:02So we have had tremendous success.

02:04And we kind of got caught up in our own success quite a bit.

02:07And we started using expressions like life-saving.

02:11I really apologise to everybody for doing that, because obviously we don't.

02:14What we do is prolong people's lives and delay death and redirect death.

02:20But we can't, strictly speaking, save lives on any sort of permanent basis.

02:24And what's really happened over the period of time that I've been working in intensive care

02:28is that the people whose lives we started saving back in the 70s, 80s and 90s

02:34are now coming to die in the 21st century

02:37of diseases that we no longer have the answers to in quite the way we did then.

02:43So what's happening now is there's been a big shift in the way that people die.

02:47And most of what they're dying of now isn't as amenable to what we can do

02:51as what it used to be like when I was doing this in the 80s and 90s.

02:56So we kind of got a bit caught up with this.

02:59And we haven't really squared with you guys about what's really happening now.

03:03And it's about time we did.

03:07I kind of woke up to this a bit in the late 90s when I met this guy.

03:11And this guy is called Jim, Jim Smith.

03:15And he looked like this.

03:16I was called down to the ward to see him.

03:18His is the little hand.

03:20I was called down to the ward to see him by a respiratory physician.

03:23He said, look, there's a guy down here, he's got pneumonia.

03:27And he looks like he needs intensive care.

03:29His daughter's here and she wants everything possible to be done.

03:34Which is a familiar phrase to us.

03:36So I go down to the ward and see Jim.

03:38And his skin is translucent like this.

03:40You can see his bones through the skin.

03:42He's very, very thin.

03:44And he is indeed very sick with pneumonia.

03:47And he's too sick to talk to me.

03:49So I talk to his daughter, Kathleen, and I say to her,

03:54did you and Jim ever talk about what you would want done

03:58if he ended up in this kind of situation?

04:00And she looked at me and she said, no, of course not.

04:04I thought, okay, take this steady.

04:08And I got talking to her.

04:10And after a while, she said to me,

04:12you know, we always thought there'd be time.

04:15Jim was 94.

04:18And I realised that something wasn't happening here.

04:21There wasn't this dialogue going on that I imagined was happening.

04:25So a group of us started doing survey work

04:28and we looked at 4,500 nursing home residents in Newcastle,

04:32in the Newcastle area,

04:34and discovered that only one in a hundred of them

04:37had a plan about what to do when their heart stopped beating.

04:40One in a hundred.

04:42And only one in 500 of them

04:44had a plan about what to do if they became seriously ill.

04:48I realised, of course,

04:50this dialogue is definitely not occurring in the public at large.

04:55I work in acute care.

04:57This is John Hunter Hospital.

04:59And I thought, surely we do better than that.

05:02So a colleague of mine from nursing, called Lisa Shaw,

05:05and I went through hundreds and hundreds of sets of notes

05:08in their medical records department,

05:10looking at whether there was any sign at all

05:12that anybody had any conversation about what might happen to them

05:15if the treatment they were receiving

05:17was unsuccessful to the point that they would die.

05:19And we didn't find a single record

05:21of any preference about goals, treatments or outcomes

05:25from any of the sets of notes initiated by a doctor or by a patient.

05:30So we started to realise that we had a problem.

05:35And the problem is more serious because of this.

05:40What we know is that obviously we are all going to die,

05:43but how we die is actually really important.

05:46Obviously not just to us,

05:48but also to how that features in the lives

05:51of all the people who live on afterwards.

05:53How we die lives on in the minds of everybody who survives us.

05:57And the stress created in families by dying is enormous.

06:02And in fact you get seven times as much stress

06:04by dying in intensive care as by dying just about anywhere else.

06:07So dying in intensive care is not your top option if you've got a choice.

06:13And if that wasn't bad enough, of course,

06:15all of this is rapidly progressing towards the fact that many of you,

06:18in fact about one in ten of you at this point,

06:20will die in intensive care.

06:22In the US it's one in five.

06:23In Miami it's three out of five people die in intensive care.

06:26So this is the sort of momentum that we've got at the moment.

06:31The reason why this is all happening is due to this.

06:33And I do have to take you through what this is about.

06:36These are the four ways to go.

06:38So one of these will happen to all of us.

06:40The ones you may know most about

06:42are the ones that are becoming increasingly of historical interest.

06:46Sudden death.

06:47It's quite likely in an audience this size

06:49this won't happen to anybody here.

06:51Sudden death has become very rare.

06:53The death of little Nell and Cordelia and all that sort of stuff

06:56just doesn't happen anymore.

06:58The dying process of those with terminal illness that we've just seen

07:02occurs to younger people.

07:04By the time you've reached 80, this is unlikely to happen to you.

07:07Only one in ten people who are over 80 will die of cancer.

07:11The big growth industry are these.

07:15What you die of is increasing organ failure

07:18with your respiratory, cardiac, renal, whatever organs packing up.

07:22Each of these would be an admission to an acute care hospital

07:25at the end of which or at some point during which

07:27somebody says enough is enough and we stop.

07:30This one's the biggest growth industry of all

07:32and at least six out of ten of the people in this room will die of this form

07:36which is the dwindling of capacity with increasing frailty.

07:43Frailty is an inevitable part of ageing

07:45and increasing frailty is in fact the main thing that people die of now.

07:50The last few years or last year of your life

07:52is spent with a great deal of disability, unfortunately.

07:56Enjoying it so far?

08:02Sorry, I feel such a Cassandra here.

08:10What can I say that's positive?

08:12What's positive is that this is happening at a very great age now.

08:15We are all, most of us, living to reach this point.

08:18Historically we didn't do that.

08:19This is what happens to you when you live to be a great age.

08:23Unfortunately, increasing longevity does mean more old age, not more youth.

08:27I'm sorry to say that.

08:33What we did anyway, look, what we did,

08:35we didn't just take this lying down at John Hunter Hospital and elsewhere.

08:38We've started a whole series of projects to try and look about

08:40whether we could in fact involve people much more

08:43in the way that things happen to them.

08:46We realise, of course, that we are dealing with cultural issues.

08:49I love this Klimt painting because the more you look at it,

08:52the more you kind of get the whole issue that's going on here,

08:55which is clearly the separation of death from the living and the fear.

08:59If you actually look, there's one woman there who has her eyes open.

09:03She's the one he's looking at and he's the one he's coming for.

09:07Can you see that?

09:08She looks terrifying.

09:10It's an amazing picture.

09:12Anyway, we had a major cultural issue.

09:14Clearly people didn't want us to talk about death.

09:16Oh, we thought that.

09:17So with loads of funding from the federal government

09:19and the local health service,

09:20we introduced the thing at John Hunter called respecting patient choices.

09:24We trained hundreds of people to go to the wards

09:27and talk to people about the fact that they would die

09:30and what would they prefer under those circumstances.

09:32They loved it.

09:33The families and the patients, they loved it.

09:3698% of people really thought this just should be normal practice

09:39and that this is how things should work.

09:43When they expressed wishes, all of those wishes came true, as it were.

09:46We were able to make that happen for them.

09:49But then when the funding ran out, we went back to look six months later

09:52and everybody had stopped again.

09:55Nobody was having these conversations anymore.

09:58So that was really kind of heartbreaking for us

10:00because we thought this was going to really take off.

10:03The cultural issue had reasserted itself.

10:07So here's the pitch.

10:08I think it's important that we don't just get on this freeway to ICU

10:13without thinking hard about whether or not that's where we all want to end up,

10:16particularly as we become older and increasingly frail,

10:19and ICU has less and less and less to offer us.

10:22There has to be a little side road off there

10:27for people who don't want to go on that track.

10:30And I have one small idea and one big idea about what could happen.

10:37And this is a small idea.

10:38The small idea is let's all of us engage more with this

10:42in the way that Jason has illustrated.

10:44Why can't we have these kinds of conversations with our own elders

10:48and people who might be approaching this?

10:51There are a couple of things you can do.

10:52One of them is you can just ask this simple question.

10:56This question never fails.

10:58In the event that you became too sick to speak for yourself,

11:01who would you like to speak for you?

11:04That's a really important question to ask people

11:06because giving people the control over who that is

11:09produces an amazing outcome.

11:11The second thing you can say is,

11:12have you spoken to that person about the things that are important to you

11:16so that we can get a better idea of what it is we can do?

11:20So that's a little idea.

11:22The big idea I think is more political.

11:24I think we have to get on to this.

11:26I suggested we should have occupied death.

11:32My wife said, yeah, right, sit-ins in the mortuary.

11:35Yeah, yeah, sure.

11:37So that one didn't really run.

11:39But I was very struck by this.

11:41I'm an ageing hippie.

11:42I don't think I look like that anymore.

11:45Two of my kids were born at home in the 80s

11:48when home birth was a big thing.

11:50We baby boomers are used to taking charge of the situation.

11:54So if you just replace all these words of birth,

11:57I like peace, love, natural death as an option.

12:00I do think we have to get political

12:02and start to reclaim this process from the medicalised model

12:05in which it's going.

12:06Now, listen, that sounds like a pitch for euthanasia.

12:08I want to make it absolutely crystal clear to you all,

12:10I hate euthanasia.

12:11I think it's a sideshow.

12:13I don't think euthanasia matters.

12:15I actually think that in places like Oregon

12:20where you can have physician-assisted suicide,

12:23you take a poisonous dose of stuff,

12:25only half a percent of people ever do that.

12:27I'm more interested in what happens to the 99.5% of people

12:30who don't want to do that.

12:32I think most people don't want to be dead,

12:34but I do think most people want to have some control

12:36over how their dying process proceeds.

12:39So I'm opposed to euthanasia,

12:40but I do think we have to give people back some control.

12:43It deprives euthanasia of its oxygen supply.

12:46I think we should be looking at stopping the want for euthanasia,

12:49not for making it illegal or legal or worrying about it at all.

12:53This is a quote from Dame Cicely Saunders,

12:57whom I met when I was a medical student.

12:59She founded the hospice movement,

13:02and she says,

13:03You matter because you are,

13:04and you matter to the last moment of your life.

13:06And I firmly believe that that's the message

13:09that we have to carry forward.

13:12Thank you.

TEDxNewy 2011: Peter Saul discusses Dying in 21st century Australia | Newcastle Herald | August 3, 2024

Category

Transcript

Recommended