OPINION

Is there a better time to talk about the end of life?

There are conversations that shouldn't take place around the table at Christmas. But one, perhaps, should: your wishes for the end of your life. It could be one of the most vital exchanges you ever have.

The ways people experience their final hours have changed with medical advances, which means it's more crucial than ever for your loved ones to make clear what they want to happen if they become seriously ill.

And will you get a better chance than the coming days to ask your mum, dad, sister or granddad about something so important?

If this doesn't strike you as festive chat, consider the experience of Hunter New England Health intensive care specialist, Dr Peter Saul.

To a TED-Ed audience in 2011, Dr Saul described patient Jim, who lay in intensive care so profoundly ill with pneumonia that his skin was translucent.

"He was too sick to talk to me. So I asked his daughter Kathleen, 'did you and Jim ever talk about what he'd want done if he ever ended up in this situation?'" Dr Saul recalled.

"She said, 'you know I always thought there'd be time'. Jim was 94. And I realised something wasn't happening here - there wasn't this dialogue going on that I imagined was happening."

A subsequent survey of 4500 aged care residents found that just one in 100 had plans for the end of their lives. Just one in 500 had plans for if they became seriously ill. But the silence around the issue ran deeper than that.

Hundreds of patients' files were bereft of any indication they had even discussed what should happen if the treatment they were receiving should fail.

And contrary to how it may seem, this is not a final chapter of life that takes care of itself.

In 2019, dying aged care residents are regularly put in ambulances and sent to emergency departments.

Once in hospital, the processes designed to keep people alive, prolong dying and cause pain and suffering.

As Melbourne respiratory registrar Dr Ashleigh Witt wrote in The Age in 2015, doctors have harrowing decisions to make about keeping a person alive before they stop trying.

The ways people experience their final hours have changed with medical advances, which means it's more crucial than ever for your loved ones to make clear what they want to happen if they become seriously ill.

"If a person's heart stops, we can perform CPR. CPR requires me to put my weight onto your mum's sternum and push," Dr Witt wrote. "To do this effectively, I will inevitably break some of her ribs. This sounds horrible, but if we don't do that, the heart doesn't pump blood to the body and without blood, we die."

Yet the overall chance of leaving hospital after CPR for all patients is 10 per cent.

So the best-case scenario, if it's your very elderly mum? You've talked about this together and have an advanced care plan.

It is difficult to overstate how much better that is than the alternative, when your mum is now too sick to talk and you've never thought about it.

This year my organisation, NSW Regional Health Partners, surveyed residents of Forster and Tuncurry. It's demographically the oldest local council area in the state.

Some locals, with tongue firmly in cheek, call it "God's waiting room". The results provide an interesting snapshot of where we're up to in the conversation. There were lots of energetic women who were very all organised with their own end of life planning, but only as a result of participating in the appalling events of their partners' deaths - some of them described these in harrowing detail.

Three-quarters of respondents said their preferred place to die would be at home, while about as many had some written plan for their end of life care, funeral or financial wishes.

Crucially, while almost 90 per cent claimed they were comfortable talking about death, only about a third had discussed with family where they would prefer to die.

Whether it's during a lull on Christmas day or over left-over prawns and the Boxing Day Test, you have the power to start this conversation.

And when the day comes, it will not be one you regret.

Professor Christine Jorm is director of NSW Regional Health Partners, a centre funded to increase the translation of research evidence into clinical practice. End of life care is a major priority.