Volume 195 - Issue 10
Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care
Author: John D Paull
Med J Aust 2011; 195 (10): 584. || doi: 10.5694/mja11.11173
Published online: 21 November 2011
Published online: 21 November 2011
To the Editor: The letter by Johnson and Mitchell,1 responding to the two published papers of Rosenwax2 and Lowthian3 and their colleagues, about hospital, ambulance and emergency department use in the last year of life, concluded with the statement:
Also essential is an ongoing dialogue with the patient and family to enable a clear understanding of the goals of treatment and to proactively plan for likely adverse events . . . [this] will potentially reduce the use of acute services and encourage the provision of care in more appropriate environments.
The most significant factor in facilitating this latter objective is the timely preparation by the patient of the appropriate form of instructions to medical staff and designated family members about end-of-life management. Unfortunately, there is no common, state-recognised instrument for this in Australia. Many people appear to believe that conferring a “power of attorney” on a family member is all that is required, but this is not the case. In most situations, this allows the designated member or members to administer financial and property matters but not to make medical decisions about end-of-life care.
The requirements for a valid medical decision-making authority differ from state to state. The instruments are variously known as: “enduring power of attorney” in the Australian Capital Territory; “enduring power of attorney (medical treatment)” in Victoria; “medical power of attorney” in South Australia; “enduring guardianship” in New South Wales and Tasmania; “enduring power of guardianship” in Western Australia; “advance health directive” in Queensland; and “medical enduring power of attorney” in the Northern Territory.
It would be a major advance in the rational use of health resources, and towards ensuring compliance with the wishes of people who are terminally ill, while minimising the stress and distress of their family members, if general practitioners were to encourage their chronically and terminally ill patients to complete the appropriate form early in their illness.
Competing interests
No relevant disclosures.
References
- Johnson CE, Mitchell GK. Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care [letter]. Med J Aust 2011; 195: 267. 0_CHDEAHJE
- Rosenwax LK, McNamara BA, Murray K, et al. Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care. Med J Aust 2011; 194: 570-573. 0_i1142861
- Lowthian JA, Jolley DJ, Curtis AJ, et al. The challenges of population ageing: accelerating demand for emergency ambulance services by older patients, 1995–2015. Med J Aust 2011; 194: 574-578. 0_i1142865