[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.58,0:00:02.60,Default,,0000,0000,0000,,Look, I had second thoughts, really,
Dialogue: 0,0:00:02.60,0:00:04.64,Default,,0000,0000,0000,,about whether I could talk about this
Dialogue: 0,0:00:04.64,0:00:07.68,Default,,0000,0000,0000,,to such a vital and alive audience as you guys.
Dialogue: 0,0:00:07.68,0:00:10.27,Default,,0000,0000,0000,,Then I remembered the quote from Gloria Steinem,
Dialogue: 0,0:00:10.27,0:00:11.90,Default,,0000,0000,0000,,which goes,
Dialogue: 0,0:00:11.90,0:00:13.84,Default,,0000,0000,0000,,"The truth will set you free,
Dialogue: 0,0:00:13.84,0:00:17.80,Default,,0000,0000,0000,,but first it will piss you off." (Laughter)
Dialogue: 0,0:00:17.80,0:00:20.06,Default,,0000,0000,0000,,So -- (Laughter)
Dialogue: 0,0:00:20.06,0:00:22.19,Default,,0000,0000,0000,,So with that in mind, I'm going to set about
Dialogue: 0,0:00:22.19,0:00:23.78,Default,,0000,0000,0000,,trying to do those things here,
Dialogue: 0,0:00:23.78,0:00:25.64,Default,,0000,0000,0000,,and talk about dying in the 21st century.
Dialogue: 0,0:00:25.64,0:00:28.04,Default,,0000,0000,0000,,Now the first thing that will piss you off, undoubtedly,
Dialogue: 0,0:00:28.04,0:00:30.66,Default,,0000,0000,0000,,is that all of us are, in fact, going to die
Dialogue: 0,0:00:30.66,0:00:31.73,Default,,0000,0000,0000,,in the 21st century.
Dialogue: 0,0:00:31.73,0:00:34.12,Default,,0000,0000,0000,,There will be no exceptions to that.
Dialogue: 0,0:00:34.12,0:00:36.78,Default,,0000,0000,0000,,There are, apparently, about one in eight of you
Dialogue: 0,0:00:36.78,0:00:39.30,Default,,0000,0000,0000,,who think you're immortal, on surveys, but --
Dialogue: 0,0:00:39.30,0:00:41.48,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:00:41.48,0:00:46.10,Default,,0000,0000,0000,,Unfortunately, that isn't going to happen.
Dialogue: 0,0:00:46.10,0:00:47.75,Default,,0000,0000,0000,,While I give this talk, in the next 10 minutes,
Dialogue: 0,0:00:47.75,0:00:51.24,Default,,0000,0000,0000,,a hundred million of my cells will die,
Dialogue: 0,0:00:51.24,0:00:53.84,Default,,0000,0000,0000,,and over the course of today, 2,000 of my brain cells
Dialogue: 0,0:00:53.84,0:00:55.98,Default,,0000,0000,0000,,will die and never come back,
Dialogue: 0,0:00:55.98,0:00:58.06,Default,,0000,0000,0000,,so you could argue that the dying process
Dialogue: 0,0:00:58.06,0:01:00.14,Default,,0000,0000,0000,,starts pretty early in the piece.
Dialogue: 0,0:01:00.14,0:01:02.25,Default,,0000,0000,0000,,Anyway, the second thing I want to say about dying in the
Dialogue: 0,0:01:02.25,0:01:04.62,Default,,0000,0000,0000,,21st century, apart from it's going to happen to everybody,
Dialogue: 0,0:01:04.62,0:01:07.23,Default,,0000,0000,0000,,is it's shaping up to be a bit of a train wreck
Dialogue: 0,0:01:07.23,0:01:09.58,Default,,0000,0000,0000,,for most of us,
Dialogue: 0,0:01:09.58,0:01:12.55,Default,,0000,0000,0000,,unless we do something to try and reclaim this process
Dialogue: 0,0:01:12.55,0:01:16.26,Default,,0000,0000,0000,,from the rather inexorable trajectory that it's currently on.
Dialogue: 0,0:01:16.26,0:01:18.07,Default,,0000,0000,0000,,So there you go. That's the truth.
Dialogue: 0,0:01:18.07,0:01:19.50,Default,,0000,0000,0000,,No doubt that will piss you off, and now let's see
Dialogue: 0,0:01:19.50,0:01:22.48,Default,,0000,0000,0000,,whether we can set you free. I don't promise anything.
Dialogue: 0,0:01:22.48,0:01:25.06,Default,,0000,0000,0000,,Now, as you heard in the intro, I work in intensive care,
Dialogue: 0,0:01:25.06,0:01:28.17,Default,,0000,0000,0000,,and I think I've kind of lived through the heyday
Dialogue: 0,0:01:28.17,0:01:30.17,Default,,0000,0000,0000,,of intensive care. It's been a ride, man.
Dialogue: 0,0:01:30.17,0:01:31.37,Default,,0000,0000,0000,,This has been fantastic.
Dialogue: 0,0:01:31.37,0:01:32.53,Default,,0000,0000,0000,,We have machines that go ping.
Dialogue: 0,0:01:32.53,0:01:34.84,Default,,0000,0000,0000,,There's many of them up there.
Dialogue: 0,0:01:34.84,0:01:37.58,Default,,0000,0000,0000,,And we have some wizard technology which I think
Dialogue: 0,0:01:37.58,0:01:40.09,Default,,0000,0000,0000,,has worked really well, and over the course of the time
Dialogue: 0,0:01:40.09,0:01:42.17,Default,,0000,0000,0000,,I've worked in intensive care, the death rate
Dialogue: 0,0:01:42.17,0:01:44.54,Default,,0000,0000,0000,,for males in Australia has halved,
Dialogue: 0,0:01:44.54,0:01:46.16,Default,,0000,0000,0000,,and intensive care has had something to do with that.
Dialogue: 0,0:01:46.16,0:01:48.16,Default,,0000,0000,0000,,Certainly, a lot of the technologies that we use
Dialogue: 0,0:01:48.16,0:01:50.38,Default,,0000,0000,0000,,have got something to do with that.
Dialogue: 0,0:01:50.38,0:01:52.89,Default,,0000,0000,0000,,So we have had tremendous success, and we kind of
Dialogue: 0,0:01:52.89,0:01:55.24,Default,,0000,0000,0000,,got caught up in our own success quite a bit,
Dialogue: 0,0:01:55.24,0:01:58.86,Default,,0000,0000,0000,,and we started using expressions like "lifesaving."
Dialogue: 0,0:01:58.86,0:02:00.100,Default,,0000,0000,0000,,I really apologize to everybody for doing that,
Dialogue: 0,0:02:00.100,0:02:02.23,Default,,0000,0000,0000,,because obviously, we don't.
Dialogue: 0,0:02:02.23,0:02:04.76,Default,,0000,0000,0000,,What we do is prolong people's lives,
Dialogue: 0,0:02:04.76,0:02:06.86,Default,,0000,0000,0000,,and delay death,
Dialogue: 0,0:02:06.86,0:02:09.70,Default,,0000,0000,0000,,and redirect death, but we can't, strictly speaking,
Dialogue: 0,0:02:09.70,0:02:12.56,Default,,0000,0000,0000,,save lives on any sort of permanent basis.
Dialogue: 0,0:02:12.56,0:02:14.54,Default,,0000,0000,0000,,And what's really happened over the period of time
Dialogue: 0,0:02:14.54,0:02:17.18,Default,,0000,0000,0000,,that I've been working in intensive care is that
Dialogue: 0,0:02:17.18,0:02:20.75,Default,,0000,0000,0000,,the people whose lives we started saving back in the '70s,
Dialogue: 0,0:02:20.75,0:02:25.23,Default,,0000,0000,0000,,'80s, and '90s, are now coming to die in the 21st century
Dialogue: 0,0:02:25.23,0:02:28.83,Default,,0000,0000,0000,,of diseases that we no longer have the answers to
Dialogue: 0,0:02:28.83,0:02:31.34,Default,,0000,0000,0000,,in quite the way we did then.
Dialogue: 0,0:02:31.34,0:02:33.22,Default,,0000,0000,0000,,So what's happening now is there's been a big shift
Dialogue: 0,0:02:33.22,0:02:35.02,Default,,0000,0000,0000,,in the way that people die,
Dialogue: 0,0:02:35.02,0:02:37.29,Default,,0000,0000,0000,,and most of what they're dying of now isn't as amenable
Dialogue: 0,0:02:37.29,0:02:40.12,Default,,0000,0000,0000,,to what we can do as what it used to be like
Dialogue: 0,0:02:40.12,0:02:44.03,Default,,0000,0000,0000,,when I was doing this in the '80s and '90s.
Dialogue: 0,0:02:44.03,0:02:46.89,Default,,0000,0000,0000,,So we kind of got a bit caught up with this,
Dialogue: 0,0:02:46.89,0:02:49.93,Default,,0000,0000,0000,,and we haven't really squared with you guys about
Dialogue: 0,0:02:49.93,0:02:53.98,Default,,0000,0000,0000,,what's really happening now, and it's about time we did.
Dialogue: 0,0:02:53.98,0:02:57.37,Default,,0000,0000,0000,,I kind of woke up to this bit in the late '90s
Dialogue: 0,0:02:57.37,0:02:59.47,Default,,0000,0000,0000,,when I met this guy.
Dialogue: 0,0:02:59.47,0:03:03.82,Default,,0000,0000,0000,,This guy is called Jim, Jim Smith, and he looked like this.
Dialogue: 0,0:03:03.82,0:03:06.13,Default,,0000,0000,0000,,I was called down to the ward to see him.
Dialogue: 0,0:03:06.13,0:03:08.37,Default,,0000,0000,0000,,His is the little hand.
Dialogue: 0,0:03:08.37,0:03:09.76,Default,,0000,0000,0000,,I was called down to the ward to see him
Dialogue: 0,0:03:09.76,0:03:10.85,Default,,0000,0000,0000,,by a respiratory physician.
Dialogue: 0,0:03:10.85,0:03:13.03,Default,,0000,0000,0000,,He said, "Look, there's a guy down here.
Dialogue: 0,0:03:13.03,0:03:14.63,Default,,0000,0000,0000,,He's got pneumonia,
Dialogue: 0,0:03:14.63,0:03:17.13,Default,,0000,0000,0000,,and he looks like he needs intensive care.
Dialogue: 0,0:03:17.13,0:03:19.21,Default,,0000,0000,0000,,His daughter's here and she wants everything possible
Dialogue: 0,0:03:19.21,0:03:21.74,Default,,0000,0000,0000,,to be done."
Dialogue: 0,0:03:21.74,0:03:24.36,Default,,0000,0000,0000,,Which is a familiar phrase to us.
Dialogue: 0,0:03:24.36,0:03:26.19,Default,,0000,0000,0000,,So I go down to the ward and see Jim,
Dialogue: 0,0:03:26.19,0:03:27.87,Default,,0000,0000,0000,,and his skin his translucent like this.
Dialogue: 0,0:03:27.87,0:03:30.12,Default,,0000,0000,0000,,You can see his bones through the skin.
Dialogue: 0,0:03:30.12,0:03:31.66,Default,,0000,0000,0000,,He's very, very thin,
Dialogue: 0,0:03:31.66,0:03:35.04,Default,,0000,0000,0000,,and he is, indeed, very sick with pneumonia,
Dialogue: 0,0:03:35.04,0:03:36.52,Default,,0000,0000,0000,,and he's too sick to talk to me,
Dialogue: 0,0:03:36.52,0:03:41.67,Default,,0000,0000,0000,,so I talk to his daughter Kathleen, and I say to her,
Dialogue: 0,0:03:41.67,0:03:44.64,Default,,0000,0000,0000,,"Did you and Jim ever talk about
Dialogue: 0,0:03:44.64,0:03:46.32,Default,,0000,0000,0000,,what you would want done
Dialogue: 0,0:03:46.32,0:03:48.34,Default,,0000,0000,0000,,if he ended up in this kind of situation?"
Dialogue: 0,0:03:48.34,0:03:52.06,Default,,0000,0000,0000,,And she looked at me and said, "No, of course not!"
Dialogue: 0,0:03:52.06,0:03:57.12,Default,,0000,0000,0000,,I thought, "Okay. Take this steady."
Dialogue: 0,0:03:57.12,0:03:59.97,Default,,0000,0000,0000,,And I got talking to her, and after a while, she said to me,
Dialogue: 0,0:03:59.97,0:04:02.97,Default,,0000,0000,0000,,"You know, we always thought there'd be time."
Dialogue: 0,0:04:02.97,0:04:06.74,Default,,0000,0000,0000,,Jim was 94. (Laughter)
Dialogue: 0,0:04:06.74,0:04:09.27,Default,,0000,0000,0000,,And I realized that something wasn't happening here.
Dialogue: 0,0:04:09.27,0:04:10.60,Default,,0000,0000,0000,,There wasn't this dialogue going on
Dialogue: 0,0:04:10.60,0:04:13.25,Default,,0000,0000,0000,,that I imagined was happening.
Dialogue: 0,0:04:13.25,0:04:16.26,Default,,0000,0000,0000,,So a group of us started doing survey work,
Dialogue: 0,0:04:16.26,0:04:18.48,Default,,0000,0000,0000,,and we looked at four and a half thousand nursing home
Dialogue: 0,0:04:18.48,0:04:21.82,Default,,0000,0000,0000,,residents in Newcastle, in the Newcastle area,
Dialogue: 0,0:04:21.82,0:04:24.76,Default,,0000,0000,0000,,and discovered that only one in a hundred of them
Dialogue: 0,0:04:24.76,0:04:27.83,Default,,0000,0000,0000,,had a plan about what to do when their hearts stopped beating.
Dialogue: 0,0:04:27.83,0:04:28.97,Default,,0000,0000,0000,,One in a hundred.
Dialogue: 0,0:04:28.97,0:04:32.31,Default,,0000,0000,0000,,And only one in 500 of them had plan about what to do
Dialogue: 0,0:04:32.31,0:04:35.40,Default,,0000,0000,0000,,if they became seriously ill.
Dialogue: 0,0:04:35.40,0:04:38.16,Default,,0000,0000,0000,,And I realized, of course, this dialogue
Dialogue: 0,0:04:38.16,0:04:42.80,Default,,0000,0000,0000,,is definitely not occurring in the public at large.
Dialogue: 0,0:04:42.80,0:04:44.28,Default,,0000,0000,0000,,Now, I work in acute care.
Dialogue: 0,0:04:44.28,0:04:46.38,Default,,0000,0000,0000,,This is John Hunter Hospital.
Dialogue: 0,0:04:46.38,0:04:50.38,Default,,0000,0000,0000,,And I thought, surely, we do better than that.
Dialogue: 0,0:04:50.38,0:04:53.38,Default,,0000,0000,0000,,So a colleague of mine from nursing called Lisa Shaw and I
Dialogue: 0,0:04:53.38,0:04:55.90,Default,,0000,0000,0000,,went through hundreds and hundreds of sets of notes
Dialogue: 0,0:04:55.90,0:04:57.17,Default,,0000,0000,0000,,in the medical records department
Dialogue: 0,0:04:57.17,0:04:59.79,Default,,0000,0000,0000,,looking at whether there was any sign at all
Dialogue: 0,0:04:59.79,0:05:02.22,Default,,0000,0000,0000,,that anybody had had any conversation about
Dialogue: 0,0:05:02.22,0:05:04.07,Default,,0000,0000,0000,,what might happen to them if the treatment they were
Dialogue: 0,0:05:04.07,0:05:07.42,Default,,0000,0000,0000,,receiving was unsuccessful to the point that they would die.
Dialogue: 0,0:05:07.42,0:05:10.36,Default,,0000,0000,0000,,And we didn't find a single record of any preference
Dialogue: 0,0:05:10.36,0:05:14.20,Default,,0000,0000,0000,,about goals, treatments or outcomes from any
Dialogue: 0,0:05:14.20,0:05:18.77,Default,,0000,0000,0000,,of the sets of notes initiated by a doctor or by a patient.
Dialogue: 0,0:05:18.77,0:05:21.49,Default,,0000,0000,0000,,So we started to realize
Dialogue: 0,0:05:21.49,0:05:23.69,Default,,0000,0000,0000,,that we had a problem,
Dialogue: 0,0:05:23.69,0:05:28.71,Default,,0000,0000,0000,,and the problem is more serious because of this.
Dialogue: 0,0:05:28.71,0:05:32.01,Default,,0000,0000,0000,,What we know is that obviously we are all going to die,
Dialogue: 0,0:05:32.01,0:05:34.68,Default,,0000,0000,0000,,but how we die is actually really important,
Dialogue: 0,0:05:34.68,0:05:38.23,Default,,0000,0000,0000,,obviously not just to us, but also to how that
Dialogue: 0,0:05:38.23,0:05:41.37,Default,,0000,0000,0000,,features in the lives of all the people who live on afterwards.
Dialogue: 0,0:05:41.37,0:05:43.69,Default,,0000,0000,0000,,How we die lives on in the minds of everybody
Dialogue: 0,0:05:43.69,0:05:46.80,Default,,0000,0000,0000,,who survives us, and
Dialogue: 0,0:05:46.80,0:05:50.54,Default,,0000,0000,0000,,the stress created in families by dying is enormous,
Dialogue: 0,0:05:50.54,0:05:53.22,Default,,0000,0000,0000,,and in fact you get seven times as much stress by dying
Dialogue: 0,0:05:53.22,0:05:55.96,Default,,0000,0000,0000,,in intensive care as by dying just about anywhere else,
Dialogue: 0,0:05:55.96,0:05:59.04,Default,,0000,0000,0000,,so dying in intensive care is not your top option
Dialogue: 0,0:05:59.04,0:06:01.50,Default,,0000,0000,0000,,if you've got a choice.
Dialogue: 0,0:06:01.50,0:06:03.66,Default,,0000,0000,0000,,And, if that wasn't bad enough, of course,
Dialogue: 0,0:06:03.66,0:06:06.31,Default,,0000,0000,0000,,all of this is rapidly progressing towards the fact that
Dialogue: 0,0:06:06.31,0:06:08.66,Default,,0000,0000,0000,,many of you, in fact, about one in 10 of you at this point,
Dialogue: 0,0:06:08.66,0:06:10.12,Default,,0000,0000,0000,,will die in intensive care.
Dialogue: 0,0:06:10.12,0:06:11.45,Default,,0000,0000,0000,,In the U.S., it's one in five.
Dialogue: 0,0:06:11.45,0:06:15.20,Default,,0000,0000,0000,,In Miami, it's three out of five people die in intensive care.
Dialogue: 0,0:06:15.20,0:06:17.26,Default,,0000,0000,0000,,So this is the sort of momentum
Dialogue: 0,0:06:17.26,0:06:19.55,Default,,0000,0000,0000,,that we've got at the moment.
Dialogue: 0,0:06:19.55,0:06:22.10,Default,,0000,0000,0000,,The reason why this is all happening is due to this,
Dialogue: 0,0:06:22.10,0:06:23.40,Default,,0000,0000,0000,,and I do have to take you through what this is about.
Dialogue: 0,0:06:23.40,0:06:25.36,Default,,0000,0000,0000,,These are the four ways to go.
Dialogue: 0,0:06:25.36,0:06:28.23,Default,,0000,0000,0000,,So one of these will happen to all of us.
Dialogue: 0,0:06:28.23,0:06:30.76,Default,,0000,0000,0000,,The ones you may know most about are the ones
Dialogue: 0,0:06:30.76,0:06:33.60,Default,,0000,0000,0000,,that are becoming increasingly of historical interest:
Dialogue: 0,0:06:33.60,0:06:35.02,Default,,0000,0000,0000,,sudden death.
Dialogue: 0,0:06:35.02,0:06:36.47,Default,,0000,0000,0000,,It's quite likely in an audience this size
Dialogue: 0,0:06:36.47,0:06:39.02,Default,,0000,0000,0000,,this won't happen to anybody here.
Dialogue: 0,0:06:39.02,0:06:40.75,Default,,0000,0000,0000,,Sudden death has become very rare.
Dialogue: 0,0:06:40.75,0:06:43.20,Default,,0000,0000,0000,,The death of Little Nell and Cordelia and all that sort of stuff
Dialogue: 0,0:06:43.20,0:06:44.88,Default,,0000,0000,0000,,just doesn't happen anymore.
Dialogue: 0,0:06:44.88,0:06:47.29,Default,,0000,0000,0000,,The dying process of those with terminal illness
Dialogue: 0,0:06:47.29,0:06:48.32,Default,,0000,0000,0000,,that we've just seen
Dialogue: 0,0:06:48.32,0:06:49.94,Default,,0000,0000,0000,,occurs to younger people.
Dialogue: 0,0:06:49.94,0:06:52.79,Default,,0000,0000,0000,,By the time you've reached 80, this is unlikely to happen to you.
Dialogue: 0,0:06:52.79,0:06:56.20,Default,,0000,0000,0000,,Only one in 10 people who are over 80 will die of cancer.
Dialogue: 0,0:06:56.20,0:07:01.04,Default,,0000,0000,0000,,The big growth industry are these.
Dialogue: 0,0:07:01.04,0:07:04.29,Default,,0000,0000,0000,,What you die of is increasing organ failure,
Dialogue: 0,0:07:04.29,0:07:06.53,Default,,0000,0000,0000,,with your respiratory, cardiac, renal,
Dialogue: 0,0:07:06.53,0:07:08.31,Default,,0000,0000,0000,,whatever organs packing up. Each of these
Dialogue: 0,0:07:08.31,0:07:10.91,Default,,0000,0000,0000,,would be an admission to an acute care hospital,
Dialogue: 0,0:07:10.91,0:07:12.88,Default,,0000,0000,0000,,at the end of which, or at some point during which,
Dialogue: 0,0:07:12.88,0:07:15.05,Default,,0000,0000,0000,,somebody says, enough is enough, and we stop.
Dialogue: 0,0:07:15.05,0:07:17.62,Default,,0000,0000,0000,,And this one's the biggest growth industry of all,
Dialogue: 0,0:07:17.62,0:07:20.20,Default,,0000,0000,0000,,and at least six out of 10 of the people in this room
Dialogue: 0,0:07:20.20,0:07:22.76,Default,,0000,0000,0000,,will die in this form, which is
Dialogue: 0,0:07:22.76,0:07:26.65,Default,,0000,0000,0000,,the dwindling of capacity
Dialogue: 0,0:07:26.65,0:07:28.97,Default,,0000,0000,0000,,with increasing frailty,
Dialogue: 0,0:07:28.97,0:07:31.22,Default,,0000,0000,0000,,and frailty's an inevitable part of aging,
Dialogue: 0,0:07:31.22,0:07:33.78,Default,,0000,0000,0000,,and increasing frailty is in fact the main thing
Dialogue: 0,0:07:33.78,0:07:34.82,Default,,0000,0000,0000,,that people die of now,
Dialogue: 0,0:07:34.82,0:07:36.95,Default,,0000,0000,0000,,and the last few years, or the last year of your life
Dialogue: 0,0:07:36.95,0:07:40.97,Default,,0000,0000,0000,,is spent with a great deal of disability, unfortunately.
Dialogue: 0,0:07:40.97,0:07:44.35,Default,,0000,0000,0000,,Enjoying it so far? (Laughs)
Dialogue: 0,0:07:44.35,0:07:47.50,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:07:47.50,0:07:50.93,Default,,0000,0000,0000,,Sorry, I just feel such a, I feel such a Cassandra here.
Dialogue: 0,0:07:50.93,0:07:56.09,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:07:56.09,0:07:57.15,Default,,0000,0000,0000,,What can I say that's positive? What's positive is
Dialogue: 0,0:07:57.15,0:07:59.56,Default,,0000,0000,0000,,that this is happening at very great age, now.
Dialogue: 0,0:07:59.56,0:08:02.31,Default,,0000,0000,0000,,We are all, most of us, living to reach this point.
Dialogue: 0,0:08:02.31,0:08:04.20,Default,,0000,0000,0000,,You know, historically, we didn't do that.
Dialogue: 0,0:08:04.20,0:08:05.67,Default,,0000,0000,0000,,This is what happens to you
Dialogue: 0,0:08:05.67,0:08:08.19,Default,,0000,0000,0000,,when you live to be a great age,
Dialogue: 0,0:08:08.19,0:08:10.08,Default,,0000,0000,0000,,and unfortunately, increasing longevity does mean
Dialogue: 0,0:08:10.08,0:08:12.00,Default,,0000,0000,0000,,more old age, not more youth.
Dialogue: 0,0:08:12.00,0:08:18.10,Default,,0000,0000,0000,,I'm sorry to say that. (Laughter)
Dialogue: 0,0:08:18.10,0:08:19.90,Default,,0000,0000,0000,,What we did, anyway, look, what we did,
Dialogue: 0,0:08:19.90,0:08:21.42,Default,,0000,0000,0000,,we didn't just take this lying down
Dialogue: 0,0:08:21.42,0:08:22.92,Default,,0000,0000,0000,,at John Hunter Hospital and elsewhere.
Dialogue: 0,0:08:22.92,0:08:24.55,Default,,0000,0000,0000,,We've started a whole series of projects
Dialogue: 0,0:08:24.55,0:08:27.54,Default,,0000,0000,0000,,to try and look about whether we could, in fact, involve
Dialogue: 0,0:08:27.54,0:08:31.04,Default,,0000,0000,0000,,people much more in the way that things happen to them.
Dialogue: 0,0:08:31.04,0:08:32.27,Default,,0000,0000,0000,,But we realized, of course, that we are dealing
Dialogue: 0,0:08:32.27,0:08:34.61,Default,,0000,0000,0000,,with cultural issues,
Dialogue: 0,0:08:34.61,0:08:36.47,Default,,0000,0000,0000,,and this is, I love this Klimt painting,
Dialogue: 0,0:08:36.47,0:08:38.68,Default,,0000,0000,0000,,because the more you look at it, the more you kind of get
Dialogue: 0,0:08:38.68,0:08:40.70,Default,,0000,0000,0000,,the whole issue that's going on here,
Dialogue: 0,0:08:40.70,0:08:44.21,Default,,0000,0000,0000,,which is clearly the separation of death from the living,
Dialogue: 0,0:08:44.21,0:08:46.09,Default,,0000,0000,0000,,and the fear — Like, if you actually look,
Dialogue: 0,0:08:46.09,0:08:47.27,Default,,0000,0000,0000,,there's one woman there
Dialogue: 0,0:08:47.27,0:08:49.19,Default,,0000,0000,0000,,who has her eyes open.
Dialogue: 0,0:08:49.19,0:08:50.87,Default,,0000,0000,0000,,She's the one he's looking at,
Dialogue: 0,0:08:50.87,0:08:54.10,Default,,0000,0000,0000,,and [she's] the one he's coming for. Can you see that?
Dialogue: 0,0:08:54.10,0:08:55.63,Default,,0000,0000,0000,,She looks terrified.
Dialogue: 0,0:08:55.63,0:08:57.32,Default,,0000,0000,0000,,It's an amazing picture.
Dialogue: 0,0:08:57.32,0:08:59.54,Default,,0000,0000,0000,,Anyway, we had a major cultural issue.
Dialogue: 0,0:08:59.54,0:09:01.52,Default,,0000,0000,0000,,Clearly, people didn't want us to talk about death,
Dialogue: 0,0:09:01.52,0:09:03.02,Default,,0000,0000,0000,,or, we thought that.
Dialogue: 0,0:09:03.02,0:09:04.97,Default,,0000,0000,0000,,So with loads of funding from the Federal Government
Dialogue: 0,0:09:04.97,0:09:06.39,Default,,0000,0000,0000,,and the local Health Service, we introduced a thing
Dialogue: 0,0:09:06.39,0:09:09.28,Default,,0000,0000,0000,,at John Hunter called Respecting Patient Choices.
Dialogue: 0,0:09:09.28,0:09:12.13,Default,,0000,0000,0000,,We trained hundreds of people to go to the wards
Dialogue: 0,0:09:12.13,0:09:15.28,Default,,0000,0000,0000,,and talk to people about the fact that they would die,
Dialogue: 0,0:09:15.28,0:09:17.56,Default,,0000,0000,0000,,and what would they prefer under those circumstances.
Dialogue: 0,0:09:17.56,0:09:21.08,Default,,0000,0000,0000,,They loved it. The families and the patients, they loved it.
Dialogue: 0,0:09:21.08,0:09:23.54,Default,,0000,0000,0000,,Ninety-eight percent of people really thought
Dialogue: 0,0:09:23.54,0:09:24.100,Default,,0000,0000,0000,,this just should have been normal practice,
Dialogue: 0,0:09:24.100,0:09:27.38,Default,,0000,0000,0000,,and that this is how things should work.
Dialogue: 0,0:09:27.38,0:09:29.32,Default,,0000,0000,0000,,And when they expressed wishes,
Dialogue: 0,0:09:29.32,0:09:31.29,Default,,0000,0000,0000,,all of those wishes came true, as it were.
Dialogue: 0,0:09:31.29,0:09:33.27,Default,,0000,0000,0000,,We were able to make that happen for them.
Dialogue: 0,0:09:33.27,0:09:35.52,Default,,0000,0000,0000,,But then, when the funding ran out,
Dialogue: 0,0:09:35.52,0:09:37.60,Default,,0000,0000,0000,,we went back to look six months later,
Dialogue: 0,0:09:37.60,0:09:39.87,Default,,0000,0000,0000,,and everybody had stopped again,
Dialogue: 0,0:09:39.87,0:09:43.06,Default,,0000,0000,0000,,and nobody was having these conversations anymore.
Dialogue: 0,0:09:43.06,0:09:45.12,Default,,0000,0000,0000,,So that was really kind of heartbreaking for us,
Dialogue: 0,0:09:45.12,0:09:47.83,Default,,0000,0000,0000,,because we thought this was going to really take off.
Dialogue: 0,0:09:47.83,0:09:51.80,Default,,0000,0000,0000,,The cultural issue had reasserted itself.
Dialogue: 0,0:09:51.80,0:09:52.96,Default,,0000,0000,0000,,So here's the pitch:
Dialogue: 0,0:09:52.96,0:09:57.05,Default,,0000,0000,0000,,I think it's important that we don't just get on this freeway
Dialogue: 0,0:09:57.05,0:09:59.54,Default,,0000,0000,0000,,to ICU without thinking hard about whether or not
Dialogue: 0,0:09:59.54,0:10:01.34,Default,,0000,0000,0000,,that's where we all want to end up,
Dialogue: 0,0:10:01.34,0:10:03.47,Default,,0000,0000,0000,,particularly as we become older and increasingly frail
Dialogue: 0,0:10:03.47,0:10:07.13,Default,,0000,0000,0000,,and ICU has less and less and less to offer us.
Dialogue: 0,0:10:07.13,0:10:09.46,Default,,0000,0000,0000,,There has to be a little side road
Dialogue: 0,0:10:09.46,0:10:13.93,Default,,0000,0000,0000,,off there for people who don't want to go on that track.
Dialogue: 0,0:10:13.93,0:10:16.57,Default,,0000,0000,0000,,And I have one small idea,
Dialogue: 0,0:10:16.57,0:10:21.02,Default,,0000,0000,0000,,and one big idea about what could happen.
Dialogue: 0,0:10:21.02,0:10:22.08,Default,,0000,0000,0000,,And this is the small idea.
Dialogue: 0,0:10:22.08,0:10:24.86,Default,,0000,0000,0000,,The small idea is, let's all of us
Dialogue: 0,0:10:24.86,0:10:28.80,Default,,0000,0000,0000,,engage more with this in the way that Jason has illustrated.
Dialogue: 0,0:10:28.80,0:10:30.85,Default,,0000,0000,0000,,Why can't we have these kinds of conversations
Dialogue: 0,0:10:30.85,0:10:32.17,Default,,0000,0000,0000,,with our own elders
Dialogue: 0,0:10:32.17,0:10:34.96,Default,,0000,0000,0000,,and people who might be approaching this?
Dialogue: 0,0:10:34.96,0:10:36.79,Default,,0000,0000,0000,,There are a couple of things you can do.
Dialogue: 0,0:10:36.79,0:10:38.92,Default,,0000,0000,0000,,One of them is, you can,
Dialogue: 0,0:10:38.92,0:10:41.84,Default,,0000,0000,0000,,just ask this simple question. This question never fails.
Dialogue: 0,0:10:41.84,0:10:45.59,Default,,0000,0000,0000,,"In the event that you became too sick to speak for yourself,
Dialogue: 0,0:10:45.59,0:10:48.53,Default,,0000,0000,0000,,who would you like to speak for you?"
Dialogue: 0,0:10:48.53,0:10:50.44,Default,,0000,0000,0000,,That's a really important question to ask people,
Dialogue: 0,0:10:50.44,0:10:52.46,Default,,0000,0000,0000,,because giving people the control over who that is
Dialogue: 0,0:10:52.46,0:10:55.77,Default,,0000,0000,0000,,produces an amazing outcome.
Dialogue: 0,0:10:55.77,0:10:56.92,Default,,0000,0000,0000,,The second thing you can say is,
Dialogue: 0,0:10:56.92,0:10:58.42,Default,,0000,0000,0000,,"Have you spoken to that person
Dialogue: 0,0:10:58.42,0:11:00.34,Default,,0000,0000,0000,,about the things that are important to you
Dialogue: 0,0:11:00.34,0:11:04.49,Default,,0000,0000,0000,,so that we've got a better idea of what it is we can do?"
Dialogue: 0,0:11:04.49,0:11:07.01,Default,,0000,0000,0000,,So that's the little idea.
Dialogue: 0,0:11:07.01,0:11:08.51,Default,,0000,0000,0000,,The big idea, I think, is more political.
Dialogue: 0,0:11:08.51,0:11:10.46,Default,,0000,0000,0000,,I think we have to get onto this.
Dialogue: 0,0:11:10.46,0:11:13.52,Default,,0000,0000,0000,,I suggested we should have Occupy Death.
Dialogue: 0,0:11:13.52,0:11:16.30,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:11:16.30,0:11:18.87,Default,,0000,0000,0000,,My wife said, "Yeah, right, sit-ins in the mortuary.
Dialogue: 0,0:11:18.87,0:11:21.45,Default,,0000,0000,0000,,Yeah, yeah. Sure." (Laughter)
Dialogue: 0,0:11:21.45,0:11:23.32,Default,,0000,0000,0000,,So that one didn't really run,
Dialogue: 0,0:11:23.32,0:11:24.99,Default,,0000,0000,0000,,but I was very struck by this.
Dialogue: 0,0:11:24.99,0:11:26.70,Default,,0000,0000,0000,,Now, I'm an aging hippie.
Dialogue: 0,0:11:26.70,0:11:29.20,Default,,0000,0000,0000,,I don't know, I don't think I look like that anymore, but
Dialogue: 0,0:11:29.20,0:11:31.70,Default,,0000,0000,0000,,I had, two of my kids were born at home in the '80s
Dialogue: 0,0:11:31.70,0:11:35.17,Default,,0000,0000,0000,,when home birth was a big thing, and we baby boomers
Dialogue: 0,0:11:35.17,0:11:37.86,Default,,0000,0000,0000,,are used to taking charge of the situation,
Dialogue: 0,0:11:37.86,0:11:41.26,Default,,0000,0000,0000,,so if you just replace all these words of birth,
Dialogue: 0,0:11:41.26,0:11:44.34,Default,,0000,0000,0000,,I like "Peace, Love, Natural Death" as an option.
Dialogue: 0,0:11:44.34,0:11:45.86,Default,,0000,0000,0000,,I do think we have to get political
Dialogue: 0,0:11:45.86,0:11:48.46,Default,,0000,0000,0000,,and start to reclaim this process from
Dialogue: 0,0:11:48.46,0:11:50.42,Default,,0000,0000,0000,,the medicalized model in which it's going.
Dialogue: 0,0:11:50.42,0:11:52.46,Default,,0000,0000,0000,,Now, listen, that sounds like a pitch for euthanasia.
Dialogue: 0,0:11:52.46,0:11:54.65,Default,,0000,0000,0000,,I want to make it absolutely crystal clear to you all,
Dialogue: 0,0:11:54.65,0:11:57.32,Default,,0000,0000,0000,,I hate euthanasia. I think it's a sideshow.
Dialogue: 0,0:11:57.32,0:11:59.50,Default,,0000,0000,0000,,I don't think euthanasia matters.
Dialogue: 0,0:11:59.50,0:12:01.66,Default,,0000,0000,0000,,I actually think that,
Dialogue: 0,0:12:01.66,0:12:04.20,Default,,0000,0000,0000,,in places like Oregon,
Dialogue: 0,0:12:04.20,0:12:07.68,Default,,0000,0000,0000,,where you can have physician-assisted suicide,
Dialogue: 0,0:12:07.68,0:12:09.89,Default,,0000,0000,0000,,you take a poisonous dose of stuff,
Dialogue: 0,0:12:09.89,0:12:11.77,Default,,0000,0000,0000,,only half a percent of people ever do that.
Dialogue: 0,0:12:11.77,0:12:14.48,Default,,0000,0000,0000,,I'm more interested in what happens to the 99.5 percent
Dialogue: 0,0:12:14.48,0:12:16.23,Default,,0000,0000,0000,,of people who don't want to do that.
Dialogue: 0,0:12:16.23,0:12:18.57,Default,,0000,0000,0000,,I think most people don't want to be dead,
Dialogue: 0,0:12:18.57,0:12:20.66,Default,,0000,0000,0000,,but I do think most people want to have some control
Dialogue: 0,0:12:20.66,0:12:23.40,Default,,0000,0000,0000,,over how their dying process proceeds.
Dialogue: 0,0:12:23.40,0:12:24.54,Default,,0000,0000,0000,,So I'm an opponent of euthanasia,
Dialogue: 0,0:12:24.54,0:12:27.20,Default,,0000,0000,0000,,but I do think we have to give people back some control.
Dialogue: 0,0:12:27.20,0:12:30.67,Default,,0000,0000,0000,,It deprives euthanasia of its oxygen supply.
Dialogue: 0,0:12:30.67,0:12:32.02,Default,,0000,0000,0000,,I think we should be looking at stopping
Dialogue: 0,0:12:32.02,0:12:33.06,Default,,0000,0000,0000,,the want for euthanasia,
Dialogue: 0,0:12:33.06,0:12:37.76,Default,,0000,0000,0000,,not for making it illegal or legal or worrying about it at all.
Dialogue: 0,0:12:37.76,0:12:41.33,Default,,0000,0000,0000,,This is a quote from Dame Cicely Saunders,
Dialogue: 0,0:12:41.33,0:12:42.70,Default,,0000,0000,0000,,whom I met when I was a medical student.
Dialogue: 0,0:12:42.70,0:12:45.58,Default,,0000,0000,0000,,She founded the hospice movement.
Dialogue: 0,0:12:45.58,0:12:47.77,Default,,0000,0000,0000,,And she said, "You matter because you are,
Dialogue: 0,0:12:47.77,0:12:50.29,Default,,0000,0000,0000,,and you matter to the last moment of your life."
Dialogue: 0,0:12:50.29,0:12:52.55,Default,,0000,0000,0000,,And I firmly believe that
Dialogue: 0,0:12:52.55,0:12:55.64,Default,,0000,0000,0000,,that's the message that we have to carry forward.
Dialogue: 0,0:12:55.64,0:12:58.66,Default,,0000,0000,0000,,Thank you. (Applause)