Two US states, Oregon and Washington subsequently adopted laws allowing physician – assisted deaths of the terminally ill. For his trouble he went to jail for eight years after a videotaped assisted suicide was shown across the country.

That  ”Dr Death” as he was called, died a  natural death has surprised some people but I wonder why this is so. Just because the Michigan Pathologist assisted in the suicide of over 100 suffering people why should it be expected that he would also take his own life sooner than was necessary.

This week on local radio 774′s  Conversation Hour  the presenter Jon Faine expressed some surprise that Kevorkian had not taken his own life but had died naturally.  This is a very simplistic response to the situation for what Kevorkian and other euthanasia activists seek is to provide relief for the terminally ill- those who have long-standing and incurable diseases.

Jack Kevorkian didn’t die after a long and intractable battle with cancer accompanied by pain and indignity; he did not suffer from motor neurone disease and its extinguishing paralysis.  From media reports of his death we  know that he was ill for a short while and so would not have needed to seek a physician assisted death for himself.

Modern death is medically controlled-you can’t escape!

Known as a “larrikin”, John has terminal cancer of the bowel and is suffering from pain that he “wouldn’t wish on his worst enemy” (A Good Death, 2010). “It throbs and throbs, shoots down your leg- it’s just too much”. John is one of four dying Australians who took part in a Four Corners documentary called A Good Death.

On the 8^th February 2010, A Good Death was broadcast on ABC television. It was produced by Four Corners, “the flagship” (McKee 2000, 34) of the Australian Broadcasting Corporation’s current affairs programming. In this episode, reporters Deborah Masters and Matthew Carney interview four terminally ill patients and their families at the Sacred Heart Palliative Care Unit in Sydney. The program records the final hours of the lives of two of these patients who die painful and undignified deaths, the manner of which is barely mentioned, let alone critiqued during the forty-five minute long program. This paper will seek to understand why Four Corners has produced a program about death that focuses positively on the system of palliative care neglecting a discussion about the failure of this practice to deliver a painfree and dignified end to the lives of these people. It will also seek to understand if and how this media representation of how we die, reflects society’s meaning of the journey of death.

Following the broadcasting of A Good Death, an online forum continued to debate the issues that had arisen in this episode of Four Corners. Over four hundred passionate viewers responded offering opinions that ranged from approval and gratitude for the palliative care nurses and specialists, to outright condemnation for the unbalanced overview of this contentious and neglected public conversation about the way we die in this society (ABC Online forum, 2010).

Respondent Lise wrote that she considered the program gave ‘a realistic picture of death in Australia’, while another contributor, Robert questioned the role of   “the catholic church in the palliative care industry” suggesting it was a “bulwark” against the voluntary euthanasia movement. Another critic accused the program of being unethical and producing “a thinly veiled infomercial on the palliative care industry”, while Zarah was concerned that the once popular art of “dying at home” didn’t rate a mention (Four Corners Online Forum 2010).

The story of these terminally ill people is filmed at a palliative care centre where they did not die as the name of the program would indicate “A Good Death”. In order to understand why this Four Corners’ program is biased towards the culture of palliative care, a textual and semiotic analysis of A Good Death will be performed along with a discussion of the major issues presented in the analysis and the role of Four Corners will also come under scrutiny. This analysis starts with an introduction to the patients whose last days of life were documented by the Four Corners’ reporters.

Norma Andrews is dying of primary bowel cancer. The frail, eighty- year old lies propped up, supported by loads of pillows, her white hair just ‘set’, and her lips painted bright red. Norma wants to die: “I go to sleep every night and hope I won’t wake up”, she tells the reporters. Diagnosed fairly late in her illness she has not long to live: “I bypassed all that nasty stuff – the chemotherapy, and everything- they said it wouldn’t do any good and there’s no need for that” (A Good Death, 2010). Norma has one daughter, Patti who visits her mother often and openly chats about the preparations she has made for Norma’s funeral. Photos of a younger and cancer-free Norma appear on our screens, and it is clear that this dying patient is a proud and independent woman who has nurtured her looks, and hates her loss of dignity. “What sort of a life is it when you’ve got to ask somebody to take you to the bathroom every time? Well if you’re thinking about can they give me a pill I know that that’s not possible” (A Good Death, 2010). The fleeting reference to euthanasia passes and Norma resigns herself to the fact that the pill is illegal.

Darryl Calver is only forty-six years old and has pancreatic cancer. He doesn’t want to die and has much to live for having recently reunited with his mother and eagerly looking forward to a life of travel with his partner Margie. The audience is introduced to Darryl as he asks his oncologist how much longer he has to live. The comforting background ‘mood’ music ceases and is replaced by a more somber and reflective track as Daryl learns that he only has a few short months left of life. Not long after hearing his ‘sentence’ Daryl is admitted to the palliative care centre with a bowel obstruction and is vomiting incessantly. He is gaunt, pale and has a distended abdomen and is noticeably breathless. The sunken-eyed man is in acute distress and sits rigidly in his hospital bed; his body is racked with pain and he is dying.

John Peart is a large man who sprawls uncomfortably over the narrow bed; his abdomen is distended, and the ubiquitous white gown hides the plastic bag that drains the artificial stoma. Peart’s family-his wife and adult children surround his bed, loving and caring until the end. His son, Reece discusses how the family had to come to terms with John’s imminent death and the concept of palliative care: “The definition of the word ‘palliative’ was quite shocking; final stages of life care. We never mentioned the definition to dad,” he said (A Good Death, 2010).

The last patient to appear on A Good Death is Sandy Riches, a sixty -three year old married woman who recently celebrated her fortieth wedding anniversary. She has been living with breast cancer for eighteen years and the disease has made its way into her bones, brain, lungs and liver.  Even so, Sandy clings to life. She’s not giving up yet because she says that “she has to be here” for her husband and she can’t imagine what will happen to him when she has gone.

The Four Corners documentary is not a pretty account of death; rather it is story of pain, distress and alienation at the end of human life. Is A Good Death a reflection of how our society understands and experiences the dying process and does this account for the way Four Corners’ presented these deaths, focusing as it did entirely on the palliative care model? Glennys Howarth claims:

Whatever the relationship between society and the individual, the media is significant as a marker of popular cultures and social mores surrounding death and dying (2007, 202).

How does the public understand real death when as Tercier explains “it is a rare lay person that has touched a body one minute alive the next dead” (2005, 210). Is there a public conversation about this inevitable end to life or are we in a state of death denial? In A Good Death, Darryl Calver sits alone in a cab on his way to an oncology appointment. He has recently made the difficult decision to stop active treatment as the ‘chemo’ is failing to arrest the growth of his pancreatic tumour. In a moment of intense intimacy, the dying man shares his frustration: “I mean we talk about the journey of life, life being a journey. Well, what about the journey of death. Isn’t that a journey as well?” ( A Good Death, 2010).

While stories about childbirth and parenthood literally leap off the weekend newspaper pages, that other mandatory journey of life — death — rarely rates a mention. It is easy to understand why we avoid thinking and writing about death. To put pen to paper and write a story about our inevitable demise is confronting and there is definitely no photo opportunity. Even so, we are curious about death: “the average eighteen year old American having watched 40,000 screen deaths” (Tercier 2005, 210).

A Good Death raised many questions about how we die in this western culture and what we regard as a good way to die. As we have very little contact with ‘real death’ where do we learn about the history and practice of dying and what is the media’s role in informing the public about our demise? Is the media’s depiction of death a reflection of our cultural attitudes and beliefs or is it instructive and does it frame our perceptions. If the media is a marker of our collective understanding of death as is suggested by Howarth (2007, 102), then how have previous films and television programs framed this final and inevitable end to life?

Howarth (2007, 102) explains that the production of movies focusing on death began at a time when dying was beginning to take place in hospital and it was becoming rare for us to have any contact with real death in our daily lives. Just as a taboo around matters of sex produced pornography in the Victorian era, our disconnection from death has led to the proliferation of death on our screens with films such as Fleming’s  “007” and Tarantino’s “Pulp Fiction”, “both famous for their violent pornography of death” (Howarth 2007, 103). This representation of violent death on the screen is not how most of us are likely to die- screen death is quick-and it does not involve “dying”. “Our real death is more likely to follow an unpleasant and protracted illness” (Howarth 2007,104).

In The Contemporary Deathbed, Postdoctoral Fellow in the History of Medicine at the University of California, John Tercier claims that death as portrayed on screen has caused a form of collective death denial (2005, 192) which he blames on popular television programs such as the American series ER which have exaggerated the survival rates of resuscitation. ER is a medical drama which on a “bad week reaches 20 million and on a good week 35 million” (Tercier 2005, 195) is set inside a frantic emergency room where viewers are “confronted almost nightly, with a technological whirlwind of death” (2005, 2). Such unrealistic expectations about saving lives Tercier asserts have lead to a cultural mantra that “all that can be done should be done” (2005, 206). The highly regarded status of resuscitation in the form of CPR, is a myth with Tercier documenting the long-term survival results for the recipients of Cardio pulmonary resuscitation and finding them to be between 1.3 and 5 percent in the major U.S cities ( 2005, 33). The unrealistic survival rates of resuscitation he suggests are manifest of our culture’s denial of death but are necessary for the survival of the series (2005, 29).

“Death with dignity the darkened room, the family gathered around the bedside, a few murmured farewells, and then an exit “gentle into that good night” (Tercier 2005, 210) has been removed from our lives and replaced with the hospital drama and its death- defying resuscitation scene (2005, 210), with “siren wailing, and the chest-pumping maelstrom of an ambulance hurtling towards the ER” (2005, 2).Clearly we have lost our way as far as understanding the process of dying.

Fiske and Hartley (2003,11) suggest television programs reveal “symbolically the structure of values and relationships beneath the surface”. “We dance around the topic of death and dying. I think for many doctors, perhaps even most doctors, death represents failure,” said Ken Hillman, Professor of Intensive Care at the University of NSW when interviewed for A Good Death (A Good Death, 2010).

In the second half of the twentieth century western cultures started to lose touch with death, mainly due to the growth in the use of medical technology leading to cures for diseases that were once fatal. Longer lives became possible and there was “a new will to master death,” (Lavi, 2008) and a patient’s demise was seen as a failure of medicine. “A cultural and psychological denial of death augmented this phenomenon” (Lavi, 2008).

To understand why A Good Death ignored discussing the painful and undignified nature of these patients’ deaths, some background on the ABC and Four Corners will now be undertaken. Four Corners which is regarded as “the flagship of ABC public affairs sessions” (Semmler cited in McKee 2001, 34) began its productive life in 1961. Never ‘a top ten’ program (McKee 2001,33) but according to the Four Corners website “part of the national story” exposing “scandals, triggering inquiries, firing debate, confronting taboos and interpreting fads, trends and sub-cultures” (Four Corners 2010). McKee (2001,315) argues that “Four Corners survives for its contribution to public debate” but in regards to A Good Death I suggest there was no debate around the issues of dying but there should have been. The ABC may be regarded as “balanced and impartial because they are free from advertising,” but as Beattie and Beal (2007, 29) claim, they are subject to “audience demands and expectations”- which means that they will go along with “current trends” in the mass media. Our society generally approves and supports this model of care for the dying with the Commonwealth and the State governments supporting palliative care access to those all those Australians who need it (Australian Government 2000).

The palliative care unit in which John, Darryl, Norma and Sandy are being cared can be regarded as a realistic depiction of death as it occurs in our western health system today. This is the method of care that our society values and regards as dying with dignity and currently there is a demand for more beds in palliative care. Ken Hillman tells the Four Corners reporters that increasingly patients are dying unnecessarily in Intensive care beds and that the health money is better spent in palliative care rather than in ICU where the cost of a bed for one day can be as high as four thousand dollars as against six hundred dollars for a palliative care bed (A Good Death, 2010).

On the other hand the controversial subject of voluntary euthanasia is not so readily embraced by the news media or the government with Prime Minister Gillard recently admitting she ‘found it a very difficult question’ (The Age, 2010). It would appear that the Gillard government has no more strength of character in this regard than previous federal governments such as the Howard government which in 1997 overturned the Northern Territories’ “Rights of the terminally ill legislation” and then “swayed by the virtue and efficacy of palliative care”, “promised to fund it generously” (The Age, 1997).

Over the recent years the ABC has suffered cuts to funding resulting in a more vulnerable public broadcaster which Errington & Miragliotta (2007, 167) fear is affecting the quality of its programming. There are instances of ‘self-censoring’ and examples of how the ABC minimizes the broadcasting of potentially controversial content for fear of political pressure from government (Errington and Miragliotta  2007, 177). The controversial issues were minimized on A Good Death and remarked upon by the online audience with participant Iola calling for a follow up episode of Four Corners where the issues of voluntary euthanasia are discussed and dares the ABC to take the discussion further.

According to the ABC act of 1983, it is the duty of the ABC Board to make sure that the information imparted by the organization is “accurate and impartial according to the recognized standards of objective journalism” (ABC 2008). Coady describes this “an attitude geared towards finding the truth” (ABC 2008), and that a range of voices are needed to reflect the diverse, views that arise from some of our most contentious issues. Journalists according to Coady (ABC 2008) must “challenge, explore and criticise where appropriate”. During the Four Corners story on the 8^th February 2010 there was no challenging, exploring or criticizing of the manner in which these patients died. This reflects poorly on the public broadcaster who rather than investigate the topic at hand, has produced a program that has avoided any critique of this contentious societal issue and cowered in the face of perceived political pressures.

The national broadcaster has a role to play in informing the public about how death occurs, for public hangings have been confined to history and very few westerners die at home these days and so “for most of us the contemporary death bed is until we lie upon our own, a virtual one” (Tercier 2005, 210). “The spectacle of the deathbed has been removed for our view” and hides itself behind curtains and closed doors of the modern hospitals and even then death is hardly recognizable as was the case when a CBC film crew recorded a man’s death in a palliative care unit in Winnipeg

An enormous audience zoomed in with anticipation on his last moments as his final breaths eased in and out. And when he died, he did it so quietly that the electronic sight and sound machinery didn’t pick up any change. The audience had to be told he was dead. (Ralston-Saul 1997, 73)

What we are witnessing in this documentary is what Illich calls (1976, 204) a “sociopolitical image of death” where the traditional knowledge of life, health and death is disregarded and people have been made into “health consumers”. “Death no longer occurs except as the self-fulfilling prophecy of the medicine man” (Illich 1976, 205).

In A Good Death, Darryl Calver shares his alienation with the audience most of whom lack the knowledge of how to die ‘a good death’ also. Denied the public conversation, Calver experienced the type of death where “western man has lost the right to preside at his act of dying” (Illich, 1976, 207). Our medical way of doing death is of recent origins and where the nineteenth century physicians couldn’t cure -they could care (Jupp&Gittings1999, 241).They may have lacked the knowledge, skills and modern drugs to cure diseases but they knew how to give the dying patient and the family moral support and spent much time sitting at the bedside. The authors of Death in England describe this caring approach as “euthanasia” which in classical Greek terminology meant “a peaceful, easy and painless death” (1999, 241. Victorian physicians knew much about hospice care for the dying and made sure that death was as easy as they could make it- dignified and comfortable. In 1995, 54 percent of people died in hospital and whereas in previous centuries doctors knew they could not cure diseases and focused on pain relief, the twentieth century medicos became more interested in cures and have increasingly abandoned the incurable (Jupp&Gittings 1999, 271).

An exit “gentle into that good night” (Tercier 2005, 210) is not how John Peart dies: the former painter and decorators’ last days are spent in unremitting nerve pain alternating with the ghastly “fog” of morphine and frequent bouts of delirium. His pain is unmanageable but even so his relatives do not ask why he is not put out of his misery. By the same token I’m certain they would not let a cat die in so much pain (A Good Death, 2010).

This paper has already noted many of the audience reactions to A Good Death and these are available online (ABC Online 2010). Many of the comments are congratulatory of the program and the ABC, and the fact that there exists such a wide range of opinions about this text leads this discussion to explore a reading and interpretation is made. For example, how do we account for the praise that was heaped upon the ABC and Four Corners by Ms Jones who wrote:

Thank god for the abc! Without programmes such as this one we would all be reduced to morons watching the mindless drivel on other networks. Fantastic programme, very moving and well done.The program was excellent (ABC 2010)

How is the story A Good Death to be understood? Why are there many different interpretations of the content? This episode of Four Corners was produced for a television audience and so an examination of how this medium presents its stories will be undertaken. Fiske & Hartley (2003) have been “Reading Television” since the 1970s and have concerned themselves with the content and how its meaning is perceived. They continue to discuss the impact and role of television in our lives and suggest that it has become “part of the public sphere” ( Fiske & Hartley 2003, xv), and an important medium through which we have witnessed the rise of political movements such as feminism, environmentalism and identity politics. Television’s relevance has persisted through the recent decades with the authors claiming that the medium “responds to the conditions within which it exists” and that reading the television message provides us with a view of larger cultural processes ( Fiske & Hartley 2003, 5). The images on our screens are known to us and television shows us an “updated version of social relations and cultural perceptions” (2003, 5).

Fiske& Hartley (2003, refer to the subject matter of a television text as the “manifest content” and in regard to A Good Death the manifest or obvious meaning is that it concerns itself with the final days of four terminally ill patients who are being cared for in the Sacred Heart palliative care unit. A fuller study of this text will reveal its true meaning and how it may be considered as a marker of our current cultural stance around matters of dying and for that “this reading of this television story must progress from the manifest to the latent content” (Fiske & Hartley 2003, 8).

Chandler (2005) alerts us to the fact that even the most “realistic” signs are not what they appear to be and that by applying a semiotic analysis we are able to see how reality is constructed and how the codes and conventions of society have influenced this state of affairs. To understand how reality has been made in A Good Death, the signs and signifiers within the text need to be identified along with the rules of society that have led to our interpretation of the text in the way that we have (Berger 1981,111). As has already been discussed the members of the audience have interpreted the text in many different ways but this is to be expected for “what is signified depends on the culture in which it is being viewed and not by some absolute truth” (Fiske and Hartley 2003, 23).

Many of the viewers of A Good Death do in fact read the text interpreting it as a caring way to die. There are many signifiers to that effect such as the close –up photo shots of caring nurses attending appreciative patients and lengthy interviews with authoritative doctors. “It’s a privilege to be with people at this time in their lives; it’s a beautiful place to be actually; it’s a lovely place to work; there’s a lot of life here amongst the death” says Nurse Compton who is supported by her colleague Louise Evans who regards it as a privilege to give patients the “tender loving care” that nurses in acute care do not have time to deliver. There are many signifiers to our cultural acceptance of this model as a caring and almost pleasant way to die running through the program. The luxurious grounds are well maintained and littered with waterfalls and grassy sunlit areas. There are two black cats “dex and morph” named after the drugs dexamethasone and morphine who prowl the grounds and bask in the sun and the whole place is embedded with kindly caring relatives from dawn to dusk and beyond if necessary. It is Christmas time at the care centre and while some patients die those still able, join the Christmas choristers and sing: “Come and behold him born the king of angels, Oh come let us adore him, Christ the lord”(A Good Death, 2010). Such scenes are familiar to this ABC audience many of whom will identify with the Christian ritual and be comforted by its presence at the place of death.

It is very important that we decode this text in order to understand how societal death is represented on the screen for our education around matters of dying has been sorely neglected. Societal rules and regulations around medicine and religion operate in this care unit for the dying, giving power to experts in the form of doctors and ministers of religion. We have learnt how these powerful institutions of medicine and religion operate in our world and understand them to be emblematic of the way our society operates and this is rarely challenged. We are well acquainted and when we become the audience of A Good Death it is difficult for us to see them as they are really; that is authoritative and prescriptive of a certain way of doing death.

As a society we have been educated to believe in the western medical system respecting it for its scientific basis and its skills; this is one of the codes or the almost tenets that operate in our society. The signifiers to our rules are operating in A Good Death: the palliative care centre is managed by Dr Chye who the viewer can recognize as representative of the medical profession. Dressed formally in dark suit and tie with his trademark stethoscope around his neck he performs his rounds of the dying patients and as he does he is followed attentively by nursing staff who attend to his orders. Patients do not complain to him and ask why they cannot have a terminal injection. This act of obedience is understood well by us for as Kellehear (2001) has written we believe that “the doctor literally knows best and the public as patients “have become increasingly passive and compliant” (Kellehear 2001).Palliative care is run along the familiar medical chain of command that we understand; this is how it works in the broader society- patients and relatives give respect to medicine and do not challenge its authority. The codes and rules of society are evident on the screen and we the audience understands. The deaths on our screens are representing the model that most of society upholds- the medical model of life.

Chandler (ABC 2005) suggests semiotics can also help us see what is not in the story:

It helps us to unpack the conventions that are involved in order to realise that convention is involved and that news or photographs are not simply reflections of a world, but are a way of building a particular view of the world.

The ways of dying presented in A Good Death is a partisan view of death and fails to discuss the problem that this system has in adequately relieving the pain and distress for many. Dr Roger Hunt ( Kuhse 1994)writes about the “rhetoric –reality gap” in regards to palliative care and as a practitioner in terminal care medicine, says that “it is a rhetorical myth that hospice and palliative care can relieve all the suffering associated with terminal illnesses” (Hunt 1994,121). The producers of A Good Death have failed to deal with this issue of pain control and omit this vital discussion about a system of care that the community and the government are urging more resources be given. The reason for the support given to palliative care both in the community and on A Good Death cannot be adequately explained without an understanding of the role of religion in society. It is very difficult to understand why the palliative care centre fails to bring about a dignified and quick death rather than the painful and prolonged agony that was endured by John Peart in the story without the history of these centres and how religion operates in society. This Four Corners episode is set inside the Sacred Heart Palliative care centre which is part of St Vincent’s Hospital, Sydney which was opened by the Sisters of Charity in 1890 as a dedicated Hospice for the Dying. The early hospices were established by religious groups who would not sanction euthanasia or suicide (Hunt 1994, 128) “Hospice rhetoric such as hospice care neither hastens nor postpones death but seeks to affirm life so that one can live fully until death occurs.”  This dogma was popular with the right to life groups which campaigned against the practice of “medically assisted death” (Hunt 1994, 128).

The role of the catholic church in palliative care makes autonomy in death impossible and as Charlesworth has written (Kuhse 1994, 207) the choice that he may wish to make to have an autonomous death or in other words to choose how he might die to is “counter to the religious beliefs around suicide and is seen as ‘cowardice and weakness” (1994, 207) and a failure to put up with the hardships of life. This refusal of palliative care to offer voluntary euthanasia comes from the religious belief that God is the person responsible for your birth and therefore has the ultimate say in when and how you will die. John Peart – is truly suffering, his pain is excruciating for his growing tumour is occupying a large part of his pelvis, and presses on lumbosacral nerves and he is being made to die like a martyr: this is no way to die and yet this is not challenged. The way that religion understand it “suicide is not an act of courage” but rather a “softness of spirit” p207 (1994, Kuhse).

This lack of discussion as to why these patients were denied autonomy in death and were forced to die painful and deaths without dignity was noted and written about online along with a call for the provision of voluntary euthanasia with such sentiment echoing the fact that eighty-five percent of Australians believe that terminally ill individuals should have a right to seek and obtain assistance to end their life with dignity (DWDV, 2006). With such a groundswell calling for a humane way to die when faced with a hopeless terminal illness then surely this must be addressed on such a program that was produced by Four Corners who are beholden to the ABC act to inform the public.

Addressing the Friends of the ABC former presenter of Four Corners Chris Masters said that as a public broadcaster program, Four Corners “has a legislative responsibility to provide independent news and current affairs,” and its programs must “inform” and “educate” (FABC 2010). Masters reminisced about how Four Corners has a history of confronting “difficult subjects” and performing “original research” and questions whether this happens anymore saying that “the game for the news industry is to get away with doing the least amount of research as possible”.

Why the program has been presented this way can be seen as a failure of Four Corners to grapple with the complex subject and may involve issues such as the lack of resources and fear of tackling the subject of euthanasia. However the public broadcaster has failed in its duty to inform the public of death and dying matters adequately and instead has presented the notion of palliative care in its current model as ‘a good death’. Death is controlled by medicine – you can’t escape.

References

ABC, 2008 ABC Charter 1983, http://www.abc.net.au/corp/pubs/ABCcharter.htm Accessed: 2/10/2010

A Good Death, Four Corners, 2010, television program, Australian Broadcasting Corporation, Australia, February 8^th. http://www.abc.net.au/4corners/content/2010/s2810506.htm

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Errington, W & Miragliotta, N 2007, Media & Politics: An Introduction, Oxford University Press South Melbourne.

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Labor MP Steph Key

The news that South Australia is to house our first  euthanasia clinic  is welcome.

A Private member’s bill on ‘the right to die‘ has been introduced into the South Australian Parliament by Labor member Steph Key.  The bill aims to give doctors a legal defence if they give medication to a terminally-ill patient which accelerates death. This does not make euthanasia legal but makes it less difficult for doctors who do want to help their patients and fear criminal charges . Dr Nitschke called the bill before the parliament ‘innovative’ and said “I think that it’s cautious, I think it’s prudent, it allows the state to get used to the idea.”

Nitschke is hopeful that the clinic to be run by Exit International, will  open in Adelaide within a month, although it would not be fully operational until the legislation has successfully passed through  both houses of State Parliament.  The proposed clinic will be run from an existing medical clinic opening about once every two weeks and will only be available to South Australian residents.

The choice of South Australia as potentially the first  state to embrace ‘the right to die’ for the terminally ill is interesting and not unexpected. The state has  a strong history of progressive reform under the leadership of Premier Don Dunstan.

Don Dunstan

During the 1970s,  his South Australian labor  government introduced many reforms: Land rights for Aborigines and the end of discrimination against race and women. The areas of education, health, housing and transport were also reformed. Dunstan was particularly interested in the Arts and while he was premier, the state was a leader in political , artistic and intellectual life.

Labor’s Steph Key is to be congratulated on her determination to see laws pertaining to euthanasia reformed. We have a right to die with dignity and without horrific pain. Let’s hope that this legislation gets up and that other MPs will have the courage and follow the very decent step that South Australia appears set to take.

Caroline Sevcikova and Barbara Hill

How Australia funds its aged care sector, regulates the industry and ensures access to quality care services were among the issues debated at a forum in Melbourne last week.

The event was hosted by National Seniors Australia to gauge public concern over the Productivity Commission’s draft report into aged care, released in January this year.

The report, Caring for Older Australians, noted Australia’s ageing population and that the ratio of people over 70 to those aged 15-64 will have doubled by 2050. It is expected that government spending on aged care will need to increase from 0.8 to 1.8 per cent of GDP over the period 2010 to 2050.

National Seniors Australia general manager of policy and research, Peter Matwijiw, called on the collective wisdom of the 90 people present at the Melbourne Town Hall:

“We need to hear your concerns about reforming the aged care system. We have performed a miracle and condensed the 507-page Productivity Commission’s draft report into a double-sided piece of paper, and now we need your experience.”

Attending the forum were aged and community care nurses, policymakers, relatives and consumers who spent the next hour and a half debating the funding of aged care, its regulation, and the issue of access and support.

How Australia pays for its aged care goes to the heart of the draft report with the Commission proposing to deregulate the present system, which could see the family home mortgaged to pay the bill. National Seniors members felt that the family home was ‘sacrosanct’ but said that if it was no longer exempt from the asset test, then the care provided would need to improve.

Quality care including nourishing food is a particular concern for Caroline Sevcikova. The former aged care caterer was scolded by her employers for ‘spoiling’ residents whenever she supplemented the prescribed menu. Sevcikova suggests that nursing homes should not be warned of impending accreditation visits. “Come accreditation day the meals are so much better, and there are flowers everywhere,” she said.

Concerns were raised about the wages and working conditions for the staff of residential care facilities. At present, nurses working in aged care are paid up to $300 a week less than their colleagues in the health sector. This disparity in wages means that there is a shortage of staff to care for ageing Australians. As the number of people aged 85 and over is projected to more than quadruple over the next 40 years, this chronic staff shortage coupled with a decreasing number of informal carers points to a need for change.

The commission’s recommendation that the current system of discrete care packages be replaced with a single, integrated, flexible system of care provision proved popular with attendees. However, there were concerns that a single entry system may be more difficult to manage for consumers with complex needs, such as those with mental health issues.

Less than 10% of older Australians live in aged care homes with the majority remaining in private dwellings; most people want to age at homeand receive care in their community. Uniting Care community worker, Jo Rodger, called for improved funding for the community sector.

“I want to see community care packages made more accessible and equitable,” Ms Rodger said. “Baby boomers will want to stay at home and not go into nursing homes.”

The passion and concern amongst the public was palpable and, as the forum drew to a close, National Seniors director of policy, Liz Curran, thanked the participants for their time and input. “You are critical to our work, and we need your support to improve the aged care system,” she said, adding that National Seniors Australia would consider the concerns expressed at the forum in their submission to the Productivity Commission, due on 21 March. The commission’s final report is expected in June.

Helen Lobato

republished from Australian Ageing Agenda

http://www.australianageingagenda.com.au/2011/03/07/article/Aged-care-reform-sparks-passionate-debate/VDUAVAAMDP

According to the Australian Nursing Foundation the draft report ignored the important issues of quality of care and workplace conditions. With more older people requiring care, there will be a substantial need for more staff and a better skill mix. Patients in nursing homes today are sicker; they often have feeding tubes, urinary catheters, and complex wounds that require specialised nursing care.

How then  have we arrived at this state of affairs where the number of nursing home residents will shortly quadruple? Why are these residents sicker and older than previously? On  Radio National’s Australia Talks there was no attention paid to this issue. There was no discussion about the fact that you can be old and crumbly and possibly in nappies  but have a high-tech pacemaker implanted in your chest? Why do we not want to discuss the fact that we are living past our use-by date?

Our lifetimes have seen great advances in medical technology;  vast industries have been built around our dependence as health consumers who swallow pills and line up for treatments until we die. For example,  the lucrative pacemaker industry is part of the huge US Medical Supplies and Devices industry that includes 12,000 companies with a combined annual revenue of about $50 billion. Modern medicine is increasingly obsessed with technology, intended to extend a person’s quantity and quality of life. More than 1 million persons in the United States have implantable pacemakers, and the majority of this population, is older than 65 years. In 2005, a survey revealed that the total new pacemakers implanted in Australia was 11,850, up from 9,498 in 2001.

Another feature of the Productivity Commission’s draft report was the reference to choice.   Mark Butler, the Minister for Mental Health and Ageing suggests that ’a lot of older Australians want to be able to consider choices about having a glass of wine at night, or a different range of bed arrangements, ensuites.’ One wonders if the minister has stepped inside a nursing home. Does choice in the form of wine at night and a private toilet and shower really matter when you are in the last days of your life and possibly demented and incontinent? Aged care is about quality and caring, not about lifestyle choices. Few people choose to go in to a nursing home – choice doesn’t really come into it.

But these vital issues around quality of life and our inevitable end were not discussed on Australia talks.

Glynis Knacker has mesothelioma. She has just weeks left to live having exhausted the  mutilating surgery, the gruelling chemotherapy and  the restorative blood transfusions. Her cancer treatments have cost in excess of two million dollars. Now Shepherd Knacker has lost his job along with his health insurance and rightly wonders whether the cancer or the cure has been worse. Glynis’s husband and carer asks the oncologist, Dr Goldman how much time the $2700 a day treatments had actually bought.  “We’ve probably extended her life a good three months” he replied to which Glynis’s husband and carer answered, “they were not a good three months”.

Glynis and Shepherd Knacker are the main characters in Lionel Shriver’s latest ‘provocative novel’ called So Much For That which “takes a hard look at America’s health-care system and asks the uncomfortable questions: how much money is one human life worth?” The book really confronts the suffering of cancer but does make me wonder if the cure is worse than the disease for Glynis does not want to give up and battles against the cancer and “refuses to let go”. Glynis’s support group talks about ‘hanging tough’ , ‘surmounting the odds’ and regards ‘dying’ as failure. Instead Glynis suffers for over one year from the effects of the surgery but also from the chemotherapy. The woman who was proud of her looks loses them along with all her body hair. She cannot eat and needs enemas if she is to open her bowels. She is prone to infections and lies watching the ‘food channel’ because it is all she can focus on and in the end she dies anyway.

Other authors have tackled this death denial culture such as Barbara Ehrenreich in her novel Smile or Die. As a breast cancer patient, Ehrenreich was encouraged to think positively and embrace cancer with a smile. Her analysis of such sugar-coating is that this comes at a great cost which is the denial of one’s true feelings of fear and anger.

In So Much For That Glynis has only three weeks left to live and her oncologist is suggesting that the dying woman avail herself of  a new experimental drug at the outrageous cost of one hundred thousand dollars for one course.

Much public debate needs to take place and such books are hopefully facilitating this.

Death comes for a young man 1856

You might be pleased to know that we are winning the dying game.

According to Peter Martin: “We are less likely to die-at any given age- than ever before”. This sounds dramatic but we are merely delaying the inevitable demise and we must still die. Martin’s article reveals our societal denial of death  with the ‘good news’ being that a young girl born this year will live into the next century.

It is not surprising that the article speaks about winning the dying game for we are accustomed to fighting disease and resisting death.  In contrast to the many stories about birth and babies there are few stories written about our inevitable demise for it is confronting and there are no cute photos shots to include. But seriously why do we celebrate our ability to live until we are 100 years or more? Is it really so wonderful that the young girl born today may live on into the 22nd century? Will the world be a pleasant place for her to live out her long life or will she be living in a depleted and dangerous world?

This article celebrates and upholds our western consumerist existence. We always want more. Why must we live longer and longer lives? Why isn’t sixty years enough?

Castle Chase Burial Ground, USK, South Wales

A natural burial is a sustainable one, accounting for 7% of burials in the U.K. Speaking on Life Matters, Ken West  who began the first natural burial site in the U.K. says that natural burial is a sustainable process that helps biodiversity. Natural burials don’t come with coffins or headstones; the body is buried in a shallow grave at a depth of two to three feet as the soil nearest the surface is more aerobic, therefore better at breaking down matter. West describes this type of burial as being vastly different to the standard variety provided by the ‘death care industry’ or the funeral industry where death is regarded as bad and putrid.  In the process of natural burial, the decomposing body is seen as positive as it is nourishing to the environment.

There are more than 200 natural or ‘woodland’ burial sites in operation across the UK and  the demand is growing. Its continuing growth is a challenge to the billion dollar funeral industry which depends on the sale of expensive coffins and memorials.

In Australia natural burial is limited to four sites and as West says  we have been pretty slow to get going with this. He suggests that  we need to talk about death and the care and disposal of the body. The private sector can be approached and in particular farmers who have the land and might want to get involved in the provision of natural burial sites.

First the conversation is about how we die, followed by the equally important issue of what happens to the body. Rather than the conventional burial or cremation our bodies can be buried in shallow graves feeding the trees under which they lay.

More information on sites:

http://www.verticalburials.com.au/

Compass- ABC

Elderly patients, unlikely to survive are increasingly the occupants of Intensive care beds.

This modern dilemma has intensified over the past few decades and has occurred alongside improvements in medical technology defying natural death. Longer lives are desirable and disease is a battle to be won.  On the ABC’s Compass program of the 31^st October, Intensive care specialist Charlie Corke explored the end of life decisions being made in intensive care units.

The program featured staff, patients and relatives in the intensive care unit of Geelong hospital and opened with shots of numerous IV pumps, ventilators and oxygen masks and a bed recently occupied, but now pointedly empty.

This is increasingly the way we are likely to die; amongst these numerous pumps that deliver life- prolonging infusions  and amongst the incessant noisy beeping of machines.

ICU’s began, according to Corke, when intensive care was needed to provide for polio victims. High technology such as offered by intensive care was initially for ill younger people but is increasingly becoming the treatment of choice for the elderly.

This episode of Compass was extremely well done: Charlie Corke put the dilemma in perspective. The intensive care specialist asked what is to done when it is obvious that a patient is not getting better and is going to take a very long time, if at all to recover.  Just how far do we go?

Vicki Taylor is a nurse working in the unit; her mother recently died in the department. “She became unwell”, says Taylor who was asked by medical staff what she thought  her mother would want in the way of treatment. Over the next few days, Taylor repeatedly asked herself  “Am I doing the right thing?” “What if I get on this tiger (treatment) and I can’t get off”.

To see a dead person is rare these days and this may be why it is difficult to accept that we must die. Many families will “take the 1 in a 1000 chance” that their loved one will live; the family feels they must keep going,” says Corke.

Corke is at pains to make clear that this intensive treatment is not pleasant and usually means that you will have a tube  down your throat and  that when you want to open your bowels, you will  do it in the bed. However, the treatment should be available, although as Corke stresses, there needs to be more consideration about what should be done rather than doing whatever is possible.

He suggests that permission may be needed for the patient to stop fighting and be allowed to die ; the family may need to tell their loved one that it is all right to go ahead and die.

In Geelong ICU there is much care being given but in the end “we can prevent death but not restore health”, says Corke.

4 Corners- ABC

Known as a “larrikin”, John has terminal cancer of the bowel and is suffering from pain that he “wouldn’t wish on his worst enemy” . “It throbs and throbs, shoots down your leg- it’s just too much”. John is one of four dying Australians who took part in a Four Corners documentary called A Good Death.

On the 8^th February 2010, A Good Death was broadcast on ABC television. It was produced by Four Corners, “the flagship” (McKee 2000) of the Australian Broadcasting Corporation’s current affairs programming. In this episode, reporters Deborah Masters and Matthew Carney interview four terminally ill patients and their families at the Sacred Heart Palliative Care Unit in Sydney. The program records the final hours of the lives of two of these patients who die painful and undignified deaths, the manner of which is barely mentioned, let alone critiqued during the forty-five minute long program.

Darryl Calver is only forty-six years old and has pancreatic cancer. He doesn’t want to die and has much to live for, having recently reunited with his mother and eagerly looking forward to a life of travel with his partner Margie. The audience is introduced to Darryl as he asks his oncologist how much longer he has to live. The comforting background ‘mood’ music ceases and is replaced by a more somber and reflective track as Daryl learns that he only has a few short months left of life. Not long after hearing his ‘sentence’ Daryl is admitted to the palliative care centre with a bowel obstruction and is vomiting incessantly. He is gaunt, pale and has a distended abdomen and is noticeably breathless. The sunken-eyed man is in acute distress and sits rigidly in his hospital bed; his body is racked with pain and he is dying.

Following the broadcasting of A Good Death, an online forum continued to debate the issues that had arisen in this episode of Four Corners. Over four hundred passionate viewers responded offering opinions that ranged from approval and gratitude for the palliative care nurses and specialists, to outright condemnation for the unbalanced overview of this contentious and neglected public conversation about the way we die in this society .

The Four Corners documentary is not a pretty account of death; rather it is story of pain, distress and alienation at the end of human life. A Good Death raised many questions about how we die in this western culture and what we regard as a good way to die. As we have very little contact with real death where do we learn about the history and practice of dying and what is the ABC’s role in informing the public about how we die?

As public hangings have been confined to history and very few westerners die at home these days and so “for most of us the contemporary death bed is until we lie upon our own, a virtual one” (Tercier 2005), we are in need of a public conversation of how we will die.  According to the ABC act of 1983, it is the duty of the ABC Board to make sure that the information imparted by the organization is “accurate and impartial according to the recognized standards of objective journalism”. Professor Coady describes this as “an attitude geared towards finding the truth”, and that a range of voices are needed to reflect the diverse views that arise from some of our most contentious issues. Journalists, according to Coady must “challenge, explore and criticise where appropriate”. During the Four Corners story on the 8^th February 2010 there was no challenging, exploring or criticizing of the manner in which these patients died. This reflects poorly on the public broadcaster who rather than investigate the topic at hand, has produced a program that has avoided any critique of this contentious societal issue.

Over the recent years the ABC has suffered cuts to funding resulting in a more vulnerable public broadcaster which Errington & Miragliotta (2007) fear is affecting the quality of its programming. There are instances of ‘self-censoring’ and examples of how the ABC minimizes the broadcasting of potentially controversial content for fear of political pressure from government (Errington and Miragliotta  2007). The controversial issues were minimized on A Good Death and remarked upon by the online audience, with participant Iola calling for a follow up episode of Four Corners where the issues of voluntary euthanasia are discussed.

A public conversation is taking place at present in regard to voluntary euthanasia with the leader of the Greens, Bob Brown planning to introduce a bill to restore the rights of the territories to make euthanasia laws. Prime Minister Gillard has said that she finds the question of euthanasia difficult and that she can’t imagine how sufficient safeguards can be put in place to avoid abuse of the elderly. Let’s hope that she doesn’t shy away from the conversation that we have to have and in which the ABC also needs to engage.

Additional References:

McKee, A 2001, Australian Television: A Genealogy of Great Moments, Oxford University Press.

Tercier, J 2005, The Contemporary Deathbed, Palgrave Mac Millan, New York.

Errington, W & Miragliotta, N 2007, Media & Politics: An Introduction, Oxford University Press South Melbourne.