What is the 'end of life' and how should we respond?

Delivered by Professor Michael Ashby

Director of Palliative Care, Royal Hobart Hospital and Southern Tasmania Area Health Service
Professor of Palliative Care, Faculty of Health Sciences, University of Tasmania, Australia

Thursday 11 October 2012, Bradley Forum

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Jointly presented with the Palliative Care Council of South Australia - marking World Hospice and Palliative Care Day

There is an ongoing global conversation about death and the process of dying. Despite half a century of clinical, academic and public policy activity by specialist palliative care workers, clinicians in most fields of health care and by many others including health administrators, academics, artists, journalists and writers, it is still common to hear the same issues recycled with the oft-repeated comment that we "do not do this well". Clinicians still struggle with treatment abatement decisions and issues related to causation and responsibility for death. The pathways to death are changing as described in Lynn's model, with increasing numbers of people dying in old age, slowly over one to two years, with multiple co-morbidities, high incidences of dementia, and more significant medical decision points. The public often have expectations of curative capacity that exceed reality (fed by a technically optimistic health industry) on the one hand, and exhibit widespread concern about bad dying on the other. Kellehear has challenged the over-medicalisation of dying and proposed a health-promoting palliative care approach of community engagement. This paper draws on a reading of international ideas and trends, and the author's experiences in three Australian states of delivering clinical palliative services, at the same time as attempting to bring about enduring changes in preparation for death both inside the health sector and in the wider community.

Professor Michael Ashby graduated from St Bartholomew's Hospital, London University in 1978, and trained in medicine and radiation oncology in the UK, France and Australia. He has held clinical, academic and managerial positions since 1989 in Adelaide and Melbourne prior to moving to Hobart in 2007. He is currently Coordinator of Theme 4 (Personal and Professional Development) in the MBBS course, and chairs the Clinical Ethics Committee at RHH.

He is a Past President of the Australia and New Zealand Society for Palliative Medicine (ANZSPM) and a past Chairman of the Chapter of Palliative Medicine at the Royal Australasian College of Physicians.

He has research interests in law, ethics and the humanities as they apply to care and decision-making at the end of life, advance care planning, and pain and symptom management. During his time as Leader of the Palliative Care Clinical Network he developed a health promotion project entitled 'Health Dying', a broad-based approach to dealing with end of life issues engaging the health professions and the wider community.

He is Consultant Editor to the Journal of Bioethical Enquiry, an editor of the Journal of Palliative Care and Mortality, and a reviewer for a number of international journals. 

Lynn J, Adamson DM. Living well at the end of life; adapting health care to serious chronic illness in old age. Arlington, VA, Rand Health, 2003.
Kellehear A.1999. Health promoting palliative care. Melbourne: Oxford University Press.
Ashby M. The Futility of Futility: Death Causation is the 'Elephant in the Room' in Discussions about Limitation of Medical Treatment. Journal of Bioethical Inquiry, 2011; 8: 151-154.  

About the Palliative Care Council of South Australia
The Palliative Care Council SA (PCCSA) is the peak body for palliative care in South Australia. It is a not-for profit organisation dedicated to supporting people living with terminal illness and those who care for them. Our mission is to influence, foster and promote the delivery of quality palliative care for all. We advocate for the needs, rights and interests of people who are dying and those who care for them, to ensure no-one in our community is overlooked when they are facing death e.g. people with disability, people with a mental health diagnosis. PCCSA brings an independent voice on Palliative Care issues and has a key role in bringing together major stakeholders - service users, volunteers, practitioners, professionals and the public.



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