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

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 hospitalisation compared with 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 health care 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 that they cannot be cared for in their community. Contributing factors include distrust of Western medicine and mainstream health care services; fear of what hospitals represent (death); fear of isolation; pragmatic concerns eg, 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 eg, 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