This thoughtful article raises a lot of important points. I agree with the comment that Western societies don't deal particularly well with death. Also, while I sympathise with the view that we should "not put the dollar first", the reality is that we all have to deal with the problem of finite resources.

An eyeopener for me has been the occasions when aged close relatives were dying in hospital. On every occasion the treating doctor gave a little speech asking whether we wanted him to suspend treatment. The choice was between intensive care, which would keep someone with very poor prognosis alive, or to suspect treatment and artificial feeding so that death was inevitable within days. My personal reaction has always been that I wanted the relative to live, but not if intervention merely prolonged their death.

I can't help comparing European values on old age and death with those on my wife's (Asian) side. The standard Aussie/European reaction to a close relative, that becomes fragile or an invalid,is to shunt them off to a nursing home, sometimes against their wishes. When my mother-in-law became frail, Asian values kicked in and her care was shared amongst family members until the end.

Finally, I would observe that a telling aspect of care for the elderly is that in most western countries it is disproportionately provided by low status immigrant workers. I don't think his reflects callousness on the part of us westerners. It does reflect distaste for medical work where the patient is not expected to get better and where the cruelty and inevitability of old age with accompanying physical and mental deterioration are on open display.

An excellent article which raises some very relevant issues. The one topic that you didnt cover Paul, which I found interesting in its absence, was that of family relations and support. My wife who is a nurse frequently mentions the sadness she feels when elderly patients in hospital are living there slowly dying, only because no family is willing to make the sacrifice to look after them. I'm not talking about those recovering from surgery or the like, but those who are just old and frail that need a bit of TLC. Surely the government would be well served financially if the family of these lovely elderly parents would care for them in the same way that these parents cared for them when they were kids. We live in a selfish culture indeed if we arent willing to care for our parents and elders.

Well it would cost the public purse a lot less, about 70% less, if people were helped to stay in and die in their own homes!
Most would prefer that and the privacy it still confers on them!
Some nursing homes are very big business, with a captive market that has produced a number of multimillionaires!
Older folk, nursing home candidates, sometimes inadvertently sign things, they just don't fully comprehend?
Marine science seems to be uncovering some pain management remedies, that put morphine in the shade, without also lowering the vitality of those who might need them.
When people poke about in their own homes, they can still feel useful.
They just need enough help in their dotage, to ensure this continues far longer, than is the current experience.
Chelation therapy is routinely bagged by some (rich) practitioners, as quackery.
Yet well over six million case studies would say otherwise, and remains a viable option to osteoporoses, gangrene and amputation; and or falling down due to a compromised brain blood supply, and breaking a hip, or a very fragile spine, which by the way, almost always ensures the elderly are institutionalised in high care and costly nursing homes.
When big pharma and or money trumps long proven, but out of patent but very efficacious medicine, the patient always/always loses out!
End of life care could be vastly improved with, HRT, routine artery opening chelation therapy, and leg ulcer curing, hypabaric oxygen therapy.
i.e. HRT, (testosterone) and fish oil, in combination, seems to help drain the amaloids, that are the cause of altziemers, similarly, chelation therapy, that crosses the blood brain barrier?
End of life care would look a lot better with preventive medicine, rather than ultra costly management models, that simply manage symptoms.
Removing health compromising conditions is not anywhere near as profitable for big pharma, which makes most of its billions from age management medicine?
Rhrosty.

A well considered thought provoking article! I've long criticised the lack of availability of GOOD palliative care. That is Hospices or dedicated units within hospitals to allow those with terminal conditions to be given excellent pain management and care to ensure maximum comfort - and also an environment more peaceful and family friendly than a hospital ward - or God forbid an ICU.

They do exist. There's simply not enough. I would advise anyone over the age of 50 or newly diagnosed with a life threatening condition to consider carefully how they would like to die and take the step to create a Advanced Health Directive. Also to talk to your nearest and dearest about how you wish to exit the stage so there's no doubt in anyones minds.

Yes we can live too long. I find it morally abhorrent treating advanced dementia sufferers vigourously for likely fatal conditions eg heart failure or pneumonia. Why do we spend so much effort and resources trying to preserve the lives of babies born with terrible congenital abnormalities?

Medicine is supposed to be the science of preserving life but it should know where and when to stop. People should have more choices at end of life stage to allow comfort and dignity and no-one but no-one should be used as surrogate lab rats.

Many studies over the years have shown that it is cheaper and the elderly have better survivability and quality of life where they are allowed to remain in their own homes.

However policy seems to be going the other way and there are all sorts of drivers. It isn't just private entrepreneurs such as developers who see and lot of money tied up in homes assets of the elderly and would like to relieve them of some of it, government at all levels is intent on doing the same. The rush is on it seems to squeeze seniors out of the homes they raised their families in and corral them into 'investing' in small retirement units and into nursing homes, build and operated by the developer lobbyists who influence government.

But increasing government taxes, and council rates that are linked to inflation in the price of real estate is a good example, and user pays are enough to ensure that the generation now in their seventies and beyond are likely to be the last who will be permitted to live their autumn years in their family home.

If government is about more than political rhetoric in saying it has the needs of seniors in mind, the first priority must be to challenge the prevailing view of age and the presumed limitations. That is a pre-requisite to any discussion of end of life.