What can we do to help Australians die the way they want to?

Hal Swerissen and Stephen J Duckett
Med J Aust 2015; 202 (1): 10-11. || doi: 10.5694/mja14.01580

A different service mix could better meet end-of-life care needs for little additional cost

Australians are not dying as they would wish. Surveys consistently show that between 60% and 70% of Australians would prefer to die at home, and that residential care facilities are their least preferred option.1

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  • Hal Swerissen
  • Stephen J Duckett

  • Health Program, Grattan Institute, Melbourne, VIC.

Competing interests:

No relevant disclosures.

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access_time 06:30, 13 April 2015

Swerissen and Duckett highlight the discrepancy between where Australians die and where they choose to die.(1) Aboriginal people are particularly vulnerable to not dying where they would wish, given paradoxical issues of higher rates of hospitalization than non-Aboriginal people, strong cultural and spiritual beliefs, and ties to “country” that underscore a widely-held desire to die at home.(2) They (and healthcare providers) face a complex juxtaposition of challenges when severely ill or dying, entrenched in a history of persecution and displacement. One such challenge is fear of relocation to city hospitals, which can be problematic when a person is so unwell they cannot be cared for in their community. Contributing factors include: distrust of Western medicine and mainstream healthcare services; fear of what hospitals represent (death); fear of isolation; pragmatic concerns e.g. financial pressures and distance; and disempowerment due to social inequalities of socio-economic status, literacy, language barrier and racism. Different beliefs and attitudes to illness and dying add further complexity, e.g. relating to illness causation, and faith in traditional healers. The desire to die “in country” reflects a profound connection to land and family, and may well outweigh physical needs at end-of-life.(2,3) Encouragingly, efforts to promote awareness and improve culturally appropriate palliative and end-of-life care for Aboriginal people, based on fundamental principles such as respect, communication and informed choice, are reflected in projects like the National Indigenous Palliative Care Project and strengths-based approaches like the Program of Experience in the Palliative Approach that targets healthcare workers caring for Aboriginal people.(4,5)


1. Swerissen H, Duckett SJ. What can we do to help Australians die the way they want to? Med J Aust. 2015 Jan 19;202(1):10-1.

2. Maddocks I, Rayner RG. Issues in palliative care for Indigenous communities. Med J Aust. 2003 Sep 15;179(6 Suppl):S17-9.

3. Australian Government. Department of Health. Providing culturally appropriate palliative care to Aboriginal and Torres Strait Islander Peoples: Resource Kit [Internet] [updated 2014 Oct 28; cited 2015 Apr 12]. Available from:

4. Australian Indigenous HealthInfoNet. National Indigenous palliative care project [Internet]. 2015 [cited 2015 Apr 12]. Available from:

5. PEPA. Program of experience in the palliative approach. Palliative Approach to Care for Aboriginal and Torres Strait Islander Health Care Providers [Internet] 2011 [cited 2015 Apr 8] Available from:

Competing Interests: No relevant disclosures

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