Everyone knows they will eventually die, yet death remains a taboo topic. But avoiding the discussion doesn’t make death go away — it just leaves us unprepared emotionally, psychologically and practically.
Around 187,000 Australians die each year. Average life expectancy is now around 82 years and more than three quarters of deaths occur in people over 70. On average, around six Australians per thousand die each year.
This is a very different pattern than around a century ago. In 1900, at 11 deaths per 1,000 population, the mortality rate was almost twice what it is today. A century ago, most deaths were from infectious disease and nearly 2 in 10 infants died in the first year of life, frequently accompanied by the death of their mother.
A walk around the Daylesford cemetery is a stark reminder of how the pattern of death and disease has changed over the past century. It is not uncommon to see the names of several children and young people on a single headstone.
Today, deaths in the first year of life and maternal mortality are rare, the result of highly successful campaigns to improve maternal and infant health that began at the start of the last century. Improvements in living standards, sewerage, housing, food and water safety and better education — combined with vaccination, reductions in smoking, greater moderation in alcohol use and improvements in road safety — have produced a dramatic reduction in early deaths.
Life expectancy in 1900 was around 50 years. Now it is 82 years, and overwhelmingly we can expect to live well into old age.
Most deaths today are from chronic conditions — heart disease, cancer and dementia — rather than infectious diseases and accidents. This shift has a significant impact on how we die and what a good death might look like. Whereas a century ago death often came after a short illness or accident, today the majority of deaths follow a relatively predictable pathway and timeline.
That means we have more choices about the practical arrangements we make and how we want to die. This includes where we want to spend our time as we are dying, what level of care and treatment we want, whether we want to choose the time and circumstance of our death, who we want to make decisions for us if we cannot, and the way we want our lives to be remembered.
A good death gives people dignity, choice and support to address their physical, personal, psychological, social and spiritual needs. It means being well informed and having control over where you die, the care you receive, who supports you, and having your symptoms well managed.
The majority of people say they would prefer to be cared for and to die at home or in home-like settings, supported by family and friends. Yet while seventy per cent of Australians say they want to die at home, only 14 per cent do so. About half of people die in hospital and a third in residential care, making dying in Australia more institutionalised than in most comparable countries.
For many — though not all — palliative care can manage pain and distressing symptoms and help people die comfortably. Victorians now also have the option of voluntary assisted dying when death is imminent and they wish to avoid the pain and distressing symptoms that can accompany it.
Dying well requires more public discussion about death and dying, and it requires each of us to think about and plan for our own deaths. That means letting people know where and how you would prefer to die — through wills, powers of attorney, medical treatment directives and advance care plans.
More broadly, we need greater investment in community-based care to support people dying from chronic illness to spend their final time at home or in home-like settings.
Join Professor Hal Swerissen, one of the key authors of the Grattan Institute report Dying Well, and Alicia Kay, Director, Verey Funerals, for a discussion of these issues at the next Daylesford Conversation.
