The Decision is a short film produced in 2017 by Ingham Institute researcher Prof. Ken Hillman.
‘I have worked as a medical specialist in intensive care for over 25 years and am appalled to witness the increasing numbers of elderly frail people who spend the last few days of their lives on life support machines. I have created the film to highlight how difficult it can be to avoid this but also how important it is that you talk about how you wish to spend the last few days of your life when that time comes.’ Prof. Ken Hillman.
The unfortunate reality in Australia is that while most of us would prefer to spend our last days at home surrounded by our loved ones, most of us actually spend our last days in a hospital surrounded by medical equipment.
We live with an aging population and a health system that is always changing to meet the challenges in our society. The elderly are now the largest population within the hospital system and the reason for their admission may not be a condition that can be actively treated, but more of a marker of age related frailty and a sign that they are nearing the end of their natural lives.
The experience of birthing today is often very well planned by the parents who usually arrive at hospital with a clear understanding of what is going to happen. Most parents have attended prenatal classes, they know where to go, what to do and what to expect. Whether written down or not there is usually a type of “birth plan” and in the end, one way or another, someone is born.
In our society the experience of dying is usually very different. “Many of us have experienced an elderly loved one coming to the end of their life in a hospital – over-treated, infantilised and, worst of all, facing a death without dignity.” says Prof. Hillman. “It is vital that we have an open discussion and inform the elderly who are attending our hospitals about their options so we can empower them to make immediate, medium and long term choices.”
Dr Virginia Apgar, a medical researcher in the early 1950’s, created the APGAR scale to help doctors determine the condition of a patient (a new born baby) and inform their next course of action. This medical research intervention takes into account 5 difference criteria to assess a patients condition and has saved countless lives and is still in use today.
Prof. Hillman and his team of researchers at the Ingham Institute have developed The Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL test) which, just like the APGAR scale, helps doctors determine the condition of a patient (an elderly frail patient) and inform their next course of action. The CriSTAL test takes into account 29 different criteria to assess whether it is in the patients best interest to carry out life-saving treatments and procedures.
Prof. Hillman and his team understand that by introducing this test into our hospitals, patients who are nearing the end of their natural lives will be recognised and more options will be discussed so that their end of life wishes can be respected.
A Living Will or “Advanced Care Directive” is a document you can complete today that should provide a clear statement your directions including your wishes and values that need to be considered before medical treatment decisions are made on your behalf. It is a document that should be completed in consultation with your family, your doctor and anyone who is important to you.
Advanced Care Directive information is currently available from NSW Health website found here.
To learn more about the research being conducted by Prof. Hillman and his team at the Ingham Institute contact us today.