Most of us will not die suddenly. As Stephen Duckett and I pointed out in the Grattan Institute’s Dying Well report, most people die after a period of decline that is now often long and predictable. Often conversations about death are avoided, but understanding and discussing the process of dying are amongst the most practical things we can do for ourselves and the people we love.
Today most of us will live well into our 70s and 80s, a huge change from the beginning of the last century 126 years ago when life expectancy was around 55. Improvements in living standards, better sanitation, sewerage, maternal and child health, vaccinations and more recently reductions in tobacco use, have seen a dramatic improvement in healthy life span. Today our focus is on healthy eating, sleeping and physical activity to maintain health.
These changes have also had a very significant impact on how we die. Infectious disease and injuries are now much less prominent and most people will die from cardiovascular disease (strokes and heart conditions), cancer or neurological conditions, particularly dementia. Often, these conditions have relatively predictable pathways to death.
The three trajectories
Health researchers generally describe three broad patterns of decline. There is the steady, predictable decline typical of cancer, where function stays relatively good until a final, often rapid, drop. There is the up-and-down pattern of organ failure — heart disease, emphysema — marked by repeated hospital admissions, each one a little harder to bounce back from. And there is the slow, gradual decline of frailty and dementia, which can stretch across years and often means the person outlives their capacity to make their own decisions.
Each trajectory asks something different of families and services. But all three raise the same question: when the time comes, where do we want to be, and who do we want making decisions if we can’t?
Planning while you still can
This is where an Advance Care Directive becomes one of the most useful documents an adult can complete — not just older Australians, but anyone. It lets you record your values and preferences, and appoint a substitute decision-maker, while you have the capacity to do so. In Victoria, this sits alongside choosing a Medical Treatment Decision Maker. Too often these conversations happen in a hospital corridor during a crisis, rather than at the kitchen table when everyone is calm.
The services available
Palliative care in Australia is under-utilised relative to need, partly because people associate it with the final days rather than understanding it as a broader approach to comfort and quality of life that can run alongside active treatment for months or years. Access varies significantly between metropolitan and regional areas — worth knowing for those of us here in Hepburn Shire, where specialist palliative care often means engaging early with community nursing and GP-coordinated care rather than assuming a hospice bed will be available locally.
For people receiving aged care support, the interface between the aged care system and palliative care has become more structured with recent reforms, though families often still find themselves navigating it for the first time at the worst possible moment. Home-based death remains what most Australians say they want, yet hospital deaths remain common — a gap that good planning and early referral to community palliative care can help close.
The experience of dying well
“Dying well” doesn’t mean a single ideal death. Our research found that what matters most to people is being free of pain and discomfort, being surrounded by people they love, and having their wishes respected. It also means families being supported, not just the dying person — grief doesn’t begin at the moment of death, and services that acknowledge that make a real difference.
Those who are terminally ill and find the process of dying is causing them intolerable suffering – something each person decides for themselves -l have the option of choosing Voluntary Assisted Dying, a process that can be discussed with family, friends and health professionals. Around 350 people use VAD in Victoria each year.
What follows
Getting the medical and legal groundwork right — the directives, the conversations, the services — creates the conditions for a death handled with dignity. But dying well doesn’t end at the last breath. What happens next, the rituals and rites that mark a life and give those left behind a way to grieve, matters just as much.
The rituals around death have shifted, and quickly. A generation or two ago, funerals in Australia followed a fairly fixed script — church service, hearse, wake, a black-clad procession. Today’s families are more likely to ask for something that reflects the person rather than the tradition: a service in a garden or on a beach, a coffin painted by grandchildren, a live-stream for relatives overseas, a celebration of life months after a simpler, private cremation. Green and natural burials are gaining interest as people think about their environmental footprint even in death. Digital legacies — social media accounts, photo archives, even AI-generated tributes — are a genuinely new problem earlier generations never had to solve. What hasn’t changed is the underlying need: a ritual, however it’s shaped, gives grief somewhere to go and gives a community a chance to say goodbye together.
Join Alicia Kay from Verey’s funerals and Professor Hal Swerissen for a Daylesford Conversation on dying well on Thursday the 16th of July from 6 – 8 pm at the Community Bank meeting room, 113 Main Road, Hepburn Springs. Please register here to help planning and seating.
