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Home » We’re Doing Dying All Wrong: Ken Hillman (Transcript)

We’re Doing Dying All Wrong: Ken Hillman (Transcript)

Here is the full transcript of Ken Hillman’s talk titled “We’re Doing Dying All Wrong” at TEDxSydney conference.

In this TEDx talk, Ken Hillman, a Professor of Intensive Care at the University of New South Wales, delves into the transformation of the dying process, particularly for the elderly, highlighting a shift from home and comfort-based end-of-life care to a highly medicalized approach in hospitals.

Through personal narratives, including the contrasting experiences of his grandfather’s and mother’s deaths, Hillman critiques the over-reliance on technology and intensive care for the elderly, emphasizing the loss of dignity and personal choice. He points out the medical community’s difficulty in recognizing and discussing end-of-life issues, proposing the need for better tools like the “crystal tool” to predict life expectancy more accurately.

Hillman advocates for honest conversations about dying, empowering patients and their families with choices about end-of-life care. He stresses that the majority of people prefer dying at home, yet the reality often involves dying in hospitals, indicating a significant mismatch between patient desires and healthcare practices. The solution, he suggests, lies in community support and the reintegration of family doctors into end-of-life care, moving away from hospital-centric models.

Hillman’s talk is a call to redefine dying, focusing on comfort, dignity, and personal preference, rather than an impersonal, technologically driven process.

Listen to the audio version here:

TRANSCRIPT:

This is a picture of my grandfather and myself in the mid-1950s, walking around Sydney. A few years later, in about 1959, my grandfather died very comfortably at home under the care of his general practitioner. This is a talk about death and dying, and it’s too late to leave as the doors are locked. But it’s about death and dying only in the very elderly, naturally and normally coming to the end of their life.

So, why was it that my grandfather was allowed to die at home quite comfortably, but my mother, 25 years later, had a very different story, which I’ll come to? One of the reasons was that, at that time, in the general practitioner’s bag, there wasn’t much more or less than what you found in hospitals. This isn’t all that long ago.

So, hospitals were where you went if you were sort of sick, but if you were poor as well, and you sat in your bed being very carefully nursed, and sometimes you got better, and sometimes you didn’t. You can see this in films at the time, where if anyone gets injured in the street, someone shot or stabbed, then there’s a bystander who shouts, “Quickly, call a doctor!” A few years later, the bystander says, “Quickly, call an ambulance!”

So, what was it in hospitals that was changing? It was about the early 1960s, and there was an explosion of technology, marvelous ways that we could image every single part of the body, complex surgery. We divided the body into “-ologies” – neurology, cardiology, gastroenterology, etc. – and the surgeons also divided the body up into different parts that they worked on and gave themselves different names.

Intensive Care

And then, of course, there was intensive care. And 25 years after my grandfather died, I became an intensive care specialist in a large London teaching hospital. I thought I could keep people alive forever. These were the early days of intensive care. I thought it was infinite, what we could be doing. And in many ways, in some ways, it is. If I had a relatively normal brain and a liver, I could keep everything else going. At that time, I had six intensive care beds.

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I now work in an intensive care unit where there are 40 intensive care beds. It costs 4000 Australian dollars per patient per day. But it’s not only the number of beds that have changed, it’s also the type of patients that we’re treating now in intensive care. Many of them are over the age of 60, many of them in their 80s and 90s, and many of those are in the last few days or weeks of life.

Conveyor Belt

So, how did this happen? Well, it’s sort of like a conveyor belt. With my grandfather, he got sick in the community, it was expected that he got treated and managed at home. If you get sick in the community these days, we almost always call an ambulance. It’s very frightening to have someone become very sick. The ambulance takes you to the nearest emergency department. Emergency departments are highly stressed. They resuscitate you, they package you, and they get you ready for admission to the hospital.

And then you become even sicker in the hospital. And here I am, at the end of the conveyor belt, in the intensive care unit, waiting for you. This is a picture of my mother and my brothers and sisters. It wasn’t the same as my grandfather, for my mother. The last six months of her life, she was admitted 22 times to acute hospitals. She wasn’t told what exactly was wrong with her. People didn’t tell her that as you get older, things start to deteriorate, and you become sicker. She wasn’t given any choice about this.

It was simply that she got sick, and she got put on this conveyor belt, admitted to hospital. I had to be a son in those situations, not a doctor, so I didn’t interfere with any of those decisions until finally a very special doctor sat us all down and said, “Your mother is old, and she’s dying, and we should let her go in peace.” That was such a relief for all of us, and of course, it was a relief for my mother. And so, approximately 48 hours after that, my mother passed very comfortably away.

Old Age

What did my mother die of? Well, when I was an intern, we were allowed to write down “old age,” but we’re not allowed to do that anymore. We have to make up a medical term. So, for example, everyone that dies, their heart stops, so we write down “cardiovascular disease.” Cardiovascular disease is the most common way of dying in our community.