As Australia's population ages, many individuals are faced with making complex medical decisions, for both themselves and others - and often during times of immense stress.
Drawing on four decades of experience as an intensive-care specialist, Dr Charlie Corke offers his thoughts on what he has learnt about deciding whether to resuscitate or not.
‘Resuscitation should not be the default action’
Dr Corke says resuscitation is a brutal and dangerous process that is not given enough weight by most people - in hospitals the survival rate of cardiopulmonary resuscitation (CPR) is around 15 per cent.
“It offers a form of life when someone has already died,” says Dr Corke.
“That can be a miracle and equally be a terrible thing because it opens up a risk of significant brain injury if the arrest has been prolonged.”
“I think there is a right for someone to not want to be a burden.”
He says despite this danger, resuscitation can become the default choice when family members are involved in the decision.
“Resuscitation changes end of life from something poetic into something mechanical and medical,” he says.
When an individual experiences cardiac arrest, relatives are asked to leave the room when doctors begin CPR, potentially robbing families and friends from being by their loved one’s side during their final moments.
“You lose the ability to have the end most people would choose.”
The grey area
The only definite point of guidance Dr Corke can offer is to keep the patient at the centre – not the family.
He says determining the level of brain damage from when a heart stops beating can be difficult, but when a poor outcome is likely it is vital to remember what the patient would want.
“I think there is a right for someone to not want to be a burden,” he explains.
“In one situation you may want it and in another you won’t. A lot of it is about using amazing medical treatment sensibly.”
Talking end of life before it happens
Dr Corke stresses the importance of thinking about end of life with family and friends before someone’s health takes a turn.
“I hear lots of people say ‘my family and doctor will know what to do’, they don’t realise it’s up to them to set these limits,” he says.
As most cardiac arrests occur after the age of 65, individuals have plenty of time to have a conversation about what they want, should someone need to make decisions on their behalf.
“When people become old and frail and some of them see great value in fighting and never giving in - it depends on the person,” says Dr Corke.
“Unless I’m given a clear instruction they don’t want it, I’m going to be relatively aggressive to do everything in my power to save the patient.”