March 27, 2010 28

‘In The End’ – Have your say about the film

By in Commentary on the film

Let us know what you think of the film

– A chance to say what you thought of the film
– See what others have said

28 Responses to “‘In The End’ – Have your say about the film”

  1. vicky potter says:

    This is a beautifully constructed film that deals sensitively with the myriad issues confronting families when dealing with end of life situations.
    It is difficult for relatives, and it is equally difficult for the doctors and nurses.
    Only when we acknowledge the difficulties and complexities can we begin to resolve the awkwardness and address the issues.
    It was a brave undertaking by the producer, and certainly goes a long way to encouraging discussion and resolution of this difficult topic.

  2. Mark says:

    I liked this film and agree with Dr Corke. It’s hard to comment from the families point of view if you haven’t been in that situation with a very close loved one so ill and perhaps close to the end. It’s easier to comment as a staff member when you know the reality of a situation and you know the quality of life (QOL) for a patient receiving these treatments is going to be much less than before they became unwell. When a person comes to ICU with a good QOL, then we should make the most of the equipment and technology to restore that person’s life. But where the person has been struggling with illness and helping them with all of these ICU technologies is just prolonging the inevitable, if not making it worse before the inevitable, then it may often be better to let nature take its course.

  3. Maria Fenby says:

    This film was beautifully presented to portray end of life issues in the ICU environment and the difficulties associated with a prolonged and inevitable death from the doctors, nurses and relatives perspectives. As Dr. Corke said on the film we have forgotten how to die. The majority of people wish to die with dignity and when patients are admitted to the ICU for treatment and have many invasive procedures performed, tubes inserted etc. and prognosis is poor it is extremely difficult for all concerned to look after these patients knowing that the end result will be death and it is just been prolonged. Also when people die after numerous weeks of support looking absolutely awful their relatives’ last memories of their loved ones will be their time in ICU , which is not a nice memory for them. Great film to help the community to discuss ‘when enough is enough’ and let people die with dignity and once only! Congratulations to all involved with the film. Excellent production.

  4. Lara Jeffery says:

    You can never really describe to people what you do as an Intensive Care Nurse. We do absolutely amazing things but I do worry about the suffering It’s so hard to look into the crystal ball and know that what you’re doing is the right thing. It is often with an extremely heavy heart as a nurse that I care for people to the extremes that medicine can offer.
    However slowly, slowly we are seeing small pockets of patients and families who have a very clear idea of how the want to live at the end of their lives.
    This film is a breath of fresh air and I think expresses the thoughts, sentiments and feelings of most of us who work in this area.

  5. Alex says:

    A great film, should be seen by all. Raises the issues around how far should we go, just because the technology is there does not mean it should be used or even offered to all patients. As an ICU nurse I struggle with some of the “treatments” that are carried out without adequate thought and discussion with the patient and or families. Well done everyone involved with this production.

  6. Emily says:

    This was a very sensitive and balanced look at the harsh realities of ICU care. For those who can return to a good quality of life it seems to be worth the “intensity”, for those who will be left debilitated and dependent it appears inappropriate and overly invasive. To look at the families experience was very valuable and I felt I learned a lot from this. Hopefully we can start to talk about end of life issues with our families and respect the varied choices we make.

  7. Bill Alcock says:

    I firmly believe that the medical system is not managing end of life care with compassion and recognition of patients `right to choose a dignified and peaceful death if quality of life is lost and this has been recorded in an advance care directive whilst of sound mind

    I find it very difficult to believe that anyone with an ounce of compassion can deny those who have lost quality of life be it degeneration or terminal illness the right to make a choice for a dignified and peaceful death provided this has been documented in an advance care directive whilst of sound mind.

    When the end is nigh, it is best to avoid hospital; the health system is geared to actively treating patients, not to recognize the dying.

    I would like to have a tattoo on my chest If I should lose quality of life please let me die with dignity”

    There are thousands of patients in hospitals and nursing homes with no quality of life lingering on indefinitely awaiting the blessing of death to release them from their despair/

    If ever I am unfortunate enough to be placed in the same situation I hope there is a sympathetic doctor around to end my life in a dignified and peaceful manner.

    If I could afford the trip I would travel to Mexico to get some Nembutal just in case of need, this would give me great peace on mind.

    In light of the governments unsympathetic attitude to end of life care I have no option but to direct in my advance care directive that if I should lose quality of life I do not want any medical treatment that will prolong my life and I do not want any sustenance or fluid; although it will take several days for me to die it is far better than the alternative.

    I am an 85 year old world war 2 veteran and it would give me great peace of mind if I could get medical assistance to die in a dignified manner if I should lose quality of life. It is my firm opinion that enforced prolonged confinement when quality of life is lost is a fate worse than death. It is inhumane to leave those who have lost quality of life whether it be a terminal illness or deterioration confined in a nursing home suffering from dementia, Alzheimer’s, and/or incontinence.

    Times have changed in my grandparents day there were no nursing homes, my parents cared for them at home, the family doctor came every other week to check on them, provide prescriptions and when they lost quality of life he asked for a family conference and was given permission to ease them out with analgesics, this was just compassion there was no mention of euthanasia.

    My strong belief in the right of everyone to make a choice for euthanasia should they lose quality of life has been influenced by two family occurrences.

    The first a heavy smoker with cancer of the throat who deteriorated quickly, I could hear him gasping for breath when I entered the hospital entrance, he could not talk, did not recognize anyone and was being fed intravenously, fortunately I was able to persuade a sympathetic doctor to ease him out in a dignified manner.

    The second a mate who served with me in the second world war and he always expressed the wish not to be confined to a nursing home, his doctor put his arm around him in my presence and said to him “Don`t you worry Tom when the time comes I will ease you out”. This gave Tom great peace of mind , however Tom was moved into a nursing home and was given medication to stop him wandering at night and crying out disturbing the patients. He deteriorated very quickly became incontinent bowels and bladder was bedridden, unable to communicate and did not recognize anyone. When I approached his doctor for help he said “sorry I cannot do anything for him now as all medication in a nursing home has to be recorded”. Tom was allowed to lie in his bed in this state for 15 months, an extremely cruel fate for someone who had served his country with distinction.

    As Nembutal is unavailable I would strongly recommend that everyone prepare an advance care directive and appoint an enduring guardian so that he/she has the authority to liaise with the doctor in the preparation of an health care management plan when quality of life is lost. The health care management plan should specify that there be no intervention or treatment aimed at prolonging life, and that any distressing symptoms caused by lack of food or fluid are fully controlled by appropriate analgesic or other treatment, even though this may shorten life. For those wishing to avoid confinement in a nursing home and distress to loved ones I would strongly recommend that this action be taken whilst of sound mind.

    In conclusion let me make it clear that it is not my intention to impose my views on anyone, however I consider euthanasia should be an option for those who have documented their wish in an advance care directive.

  8. lisa says:

    How refreshing to hear a doctor acknowledge that everybody dies and that medicine can, at best, delay dying…not prevent it.If only there was more honest and early discussion between individuals, their families and their health care providers about when death is likely to happen.

    In England, many health services have introduced the concept of the ‘suprise’ question…’would you be suprised to hear that this person has died in the next 12 months?’ If the answer is yes, then end of life planning and discussion is started.

    Not everyone will want to talk about dying…but many people who have worsening health and increasing fraility want to be able to wrap things up and to prepare themselves and the ones they love for end of life.

    Having an understanding that dying is expected, and anticipated, can open conversations about what is important to the individual at the end of their life. Some people will choose to accept treatment that is offered to delay dying; others will accept natural dying and choose treatment that relieves discomfort. Both are equally valid choices. The only way for people to know what an individual wants is to talk about dying.

    Again, Charlie said it right when he stated that those who know the most about treatment options are the ones who are least likely to want them! Become informed about what treatment outcomes are..Learn to ask questions..Learn how to say the words death and dying in a discussion. Tell your family and your doctors what your preferences are when your end of life approaches.

  9. Silvia Ford says:

    What a wonderful human being is Dr Charlie Corke. I do hope that this film encourages family members to discuss this issue. I have daughters who refuse to talk about my eventual death & it worries me that I could end up on life support, I am 73 & have heart failure.
    My husband died here at home 6 years ago, he had stomach cancer & had to have his pain managed with morphine. He died holding my hand, in his own home, as he wanted, it was a peaceful & loving death. We should all be allowed to die with dignity.

  10. DeniseB says:

    I have just finished watching the documentary.
    It was well done in every way.
    I used to practice as a nurse. I cannot believe the direction medicine has taken in relation to
    care of the elderly in an I.C.U.
    I would have thought there were medical policies in place regarding extensive intervention. This needs to be addressed urgently.
    Also, where are the counsellors for these families to guide them through the grieving process? Nurses are wonderful in this regard but they are very busy. A very timely report. Well done Geelong team, producers etc

  11. drew wenck says:

    A great job. I loved the doco, it was very well done.
    Our reaction to try to prevent death ‘at all costs’ is a problem – and the emotional cost is going up.
    The film did focus only on the elderly but the same thing can happen to younger people, However, the elderly are certainly over represented in ICUs.

  12. Helen says:

    I felt so sad watching this show but as we get older we look for answers to our many questions about dying, my Mother died in 1998 I was called during the night to say that her kidneys were failing I replied that I would be in straight away, oh no they said don’t come in now, come in, in the morning.

    When we arrived a nurse greeted us with I thought you wouldn’t be here in time, the Doctor wants to see you, but while we were waiting for him I heard my Mother’s voice as strong as anything, saying Oh NO, and he had just told her she was dying without speaking to the Family that knew and loved her, he said to us when he came back you have a small window of opportunity to say goodbye here

    So when he started talking out this *window of opportunity* I said to him do you know that my Mother is frightened of dying, why would you tell her this, why would you not consult us, I was breaking my heart, then I heard my Mother call out *where is my baby* I was the last of her children, I rushed down and cuddled her, and said Mum when you see my Dad give him a big kiss for me, ohhh don’t you worry I will, she cuddled my husband and two daughters, and then they increased the medications and there was no more talking, they said she could probably hear me but I was still in shock, if I had of been prepared I could have held her hand, massaged her face, so many things but this was so new to me and it was something new they were experimenting with but leaving out telling me I was going to lose my Mother.

    To this day I reproach myself for not doing more and I have nightmares about it, my Father died when I was 13, they lost their first child after two weeks and another son drowned and my sister died at 50, I think we were part of an early experiment and it failed.

    Watching the show tonight I have to agree there is no dignity in being attached to machines, I don’t want to be kept alive and my family know that, but they would need to know that there is no hope because you could leave them grieving for the rest of their lives if there were any doubts, you must cover all bases because my Mother’s death never leaves me, at one stage she opened her eyes and said *what is taking so long*, her brother who was there too said *Sis there is a queue and you have to wait your time* I have to live with that as well, Mum just shut her eyes and they adjusted the medications again and it wasn’t long before she went and this was a Catholic Private Hospital.

  13. Charlie Corke says:

    Dr Charlie Corke.
    Reading some of the feedback I feel that some suggest that there should be something like a ‘policy’ to limit intensive treatment. I am uncomfortable with this.
    Medicine is great because it does work. Our society is good because access to excellent medical care is available to all.
    Intensive medical treatment is there for those who want it and it is my privilege to be able to provide it – and it is fantastic when it works.
    Prolonged intensive treatment can be awful for the person receiving it and for their family.
    I simply want to suggest the need for everyone to be more thoughtful about the decisions that we make.

  14. Sam says:

    I thought this was a beautifully presented documentary and only hope that this encourages people to discuss end of life wishes with their families while they are ‘well’- a difficult and emotional time in my experience but also surprising. Putting this down on paper in the form of an advanced care plan can also provide some comfort to loved ones that your wishes at end of life are as you wanted. Well done to the Geelong team for bringing this to our attention.

  15. Karen says:

    This wonderful film is so timely for me, my dearly loved mother is in precisely this situation at present. My siblings and I have been asked to consider withdrawing treatment as her response to long-term (several months) intervention has been very poor. She doesn’t want to suffer any more she tells us, and we have finally come to the same conclusion that Dr Corke has – sometimes the most loving thing to do is to let people go.

  16. Sarah says:

    I am a geriatrician at a large teaching hospital.

    I feel that it is a vital part of my role to provide an expert opinion and recommendation about medical treatment. Often this means advising against some treatments and procedures and protecting patients from treatments which may prove burdensome and “death-prolonging”. I often find myself trying to protect family members form the guilt they feel when the decision to treat or not is placed entirely in their hands.

    This debate should not be seen as rationing health care but rather providing reasonable and sensible care where there is an honest conversation between the health professionals, patients and their families about what outcomes can reasonably be expected. Its a lot easier to discuss the limits of what can be done before you start treating. A lot of doctors are terrible at this.

    This is a great film. I can’t stress how important it is for people to discuss how they want to be treated at the end of their lives with their families and their doctors. One never knows when they will find themselves on the position of advocate for a loved-one when they cannot speak for themselves. Knowing what they would want is one of the best things you could do for them.

  17. Jirinka says:

    As an ICU nurse I found this documentary extremely moving… I really hope that as a culture and a society we can begin to talk about these issues more openly so we can provide the care that is respectful to the wishes of the patient.

  18. Pam Strain says:

    This documentary was very moving for me because it portrayed the exact position I was in seventeen months ago when my father passed away in that exact ICU. He was a very frail 84 y.o. and after 4 days the life support was switched off, but not before we had to watch him undergo the indignity intensive care entails. To this day I feel that I failed him, because even though he was unconscious, I can’t believe that he wasn’t suffering and screaming for release. Charlie, you have made a very valid point about the importance of receiving appropriate information. With Dad he often joked about dying, and he had certainly prepared for it, but I am not sure that he ever saw inside an ICU. I certainly never had until his death. He would have wanted a good shot at recovery if that was a reasonable expectation, but I am pretty sure if he knew what lay ahead of him he would not have wanted us to call that ambulance. If only I could rewind and ensure that he had a death where there was just him in the bed and not all that modern technology offers in there with him. Hopefully this discussion will help others avoid what is now my worst memory.

  19. Meg says:

    As a nurse, I have worked in Palliative care for years and I am also a lecturer at Tafe. I first watched the film on Compass, ABC2, and a student bought in a copy he had purchased to show the class,as they had been learning about a Palliative Approach to Care as part of their Certificate III in Aged Care. As the film depicts the alternative so beautifully, my class was very impressed, it engendered lots of discussion points for them and much to think about.
    Tafe has now purchased a copy to show to students across four different programs – Complementary Therapies, Diploma Of Nursing,Health Assistants and Aged Care. It is considered to be an important resource for all of them, and added to the session plans. Thankyou for tackling a difficult topic in such a sensitive manner, and being part of the “catalyst” for change and increased knowledge in these areas.

  20. Ruth says:

    As a residential aged care RN I’ve recommended this powerful and moving documentary to my colleagues. We constantly discuss the ethical dilemmas of prolonging residents’ lives (many of who have multiple chronic illnesses, incontinence and dementia) with cardiac drugs and influenza shots, but this pales in comparison to the aggressive and intrusive treatments shown in this film. Apart from the ongoing trauma to elderly ICU patients and their families, I would be very concerned about the psychological wellbeing of the medical and nursing staff. They must feel conflicted and confused coming into work each day, being so unsure of the ethics of the treatments being used.

    Along with the emerging discussion of Advanced Care Planning, hopefully this documentary will stimulate conversations in many families about what elderly people would wish for in their final days.

    Thankyou for a wonderful film.

  21. julie pinkham says:

    thankyou for a great documentary; so thought provoking. I think it will make a difference.

  22. susan bentley says:

    Hi I am an ICU nurse and have faced this delemia several times not only in australia but in africa where I was born and raised.Life is precious but so are the wishes of your loved one, my own mother said to my sister when she was dying let me go as all my friends have gone before me there is nothing here for me anymore. So we honoured her dying wish as much as it hurt, but she died with dignity and every single one of her offspring truely believed that she did not suffer in the end. This dvd is a help to medical staff who have a hard time letting go after all the time and effort they have put in to saving someone’s life, it should be on the must see list of every medical course run in this country, thankyou for showing it again.

  23. sue says:

    As long as Dr Charlie Corke is teaching the youngsters I am content. One of life’s wonderfully accomplished, compassionate examples of the best of the species, same species as me believe it or not.

  24. helen ellerker says:

    I would like to thank Dr Charlie Corke for the thoughtful, empathic program screened on the ABC, 13 June 11. I was so happy to hear someone from the medical profession actually recognise and articulate some of the complex issues surrounding the loss of dignity and in some cases, psychological suffering that some elderly people, at the end of their lives, are made to endure, even when it is well known, death is inevitable.

    In my own 87 year old mother’s case, despite her expression of a wish to be let go, expressed with difficulty, several times, and my attempts on her behalf, her wishes were totally ignored and she, with one of her hands tied, was made to endure the insertion of tubes down her throat into her lungs for 3 weeks. Only one hand was tied because the other had become paralysed as a result of one of 2 ‘open heart’ operations. My mother developed pneumonia as well, following the operations, and would constantly gag with the irritation from the invasive tubes down her throat. It was so uplifting to hear a different view from the platitudes we were constantly hearing, about ‘the need to fight’ and ‘the need to be strong’.
    I do hope this program starts to bring about a greater examination of the ethics associated with the complexity of issues surrounding the ‘tunnel-visioned’ use of technology only to cause those who are helpless, at the end of their lives, such loss of dignity and needless suffering. The ongoing trauma experienced by the patient is mirrored by the family members who are watching. Thank you again Charlie.

  25. Heather Tobias says:

    I hope that this documentary is shown to medical students in universities. Because younger people have come to expect that medical science can achieve the near impossible they seem to believe they have the right to demand miracles. As a 74 year old whose great grandmother died at, and was buried from, our home in East Malvern, Victoria. I was 10. I have always accepted death as part of life. In recent years I have been very disturbed by the attitude to the status of (especially) elderly patients at the end of their life. When technology,which is supposed to help humans,is used in a manner that dehumanizes the last stages of life there is something very wrong with the way we think. I have been very afraid of the possible intervention in my future unescapable date with death. Surely if we love we cannot demand a life not lived? Listening to Dr Charlie Corke’s sensitive, empathic discussion with staff, students and families I saw a glimmer of hope that I maybe able to die as my great grandmother, my grandmother and my mother before me: in peace.

  26. Richard Lea says:

    A wonderful documentary about a very complex stage of life. As a consultant anaesthetist, I see a significant number of patients undergoing surgery when it is unlikely to prolong life or even to improve the quality of life.

    That “the medical system” allows this to happen is not simply a function of Doctors who can’t help themselves prolonging life at any cost. There are many who, like Charlie Corke, see the futility and indignity in complex medical and surgical treatments towards the end of life.

    Unfortunately so many people have not discussed their desires with family and friends and many people have unresolved issues with family. In these situations it is common for one or more of the family or friends to push, sometimes quite aggressively, for ‘everything possible’ to be done, even if the future is prolonged invasive care in ICU and very poor long term prospects for their loved one. They can’t imagine bear their loved one dying, or are still hoping to resolve some lingering unspoken issue.

    If you believe in what Charlie Corke is saying , as I do, get out and talk to people about it. Demystify death. Mend old conflicts with your loved ones. Decide how poorly you would be prepared to live. Would it be OK for you if you were incontinent, confined to bed, unable to talk? Discuss it with your loved ones and your Doctor and write it down. Make sure they all know your wishes.

    It is too late to leave it until you are very ill, you never know when that is going to happen.

  27. Christine says:

    Please show this film again in prime time, every time. Every Human being ought to see it. We are adults and as such, responsible for our own destinies, thoughts and decisions. My deep appreciation to Dr Charlie Corke not only for his courage but also for being such a remarkable and unique Human being in a world where ‘business etiquette’ seems to rule the medical profession. The compassion, clarity and humanitarian grounds shown in this film is compelling. Thank you to all who made this possible.

  28. Rex Williams says:

    This was a video that should be mandatory viewing by anyone over the age of 16. It has a place in the High School curriculum as a source of education and to understand the principles as clearly identified by ICU specialist, Dr. Corke.

    The most relevant comment in the video was..”we can prevent death, but not restore health”

    Everyone should understand such a comment.

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