Dr Clare Skinner, an emergency medicine registar and health reform advocate, recently wrote this article, encouraging us to start thinking about how we want to die and related issues of how we want our health dollars spent.

Do we want a high-tech death, involving expensive but futile interventions?  Or do we want to refocus health spending and priorities towards the areas that might make a real difference to the community’s health (such as early childhood)?

Related questions sprang to mind for Dr Peter Arnold while perusing the latest annual report from the Private Health Insurance Administration Council.

Arnold, a retired GP and regular contributor to public debate, writes:

“Faced with wounds which could rapidly become infected and gangrenous, with fatal results, Napoleon’s surgeon-general, Baron Dominique Jean Larrey, instituted a method of sorting – triage, [from the French ‘trier’ to sort]; those soldiers who could return to the battlefield were given priority attention, followed by those who could be treated but were unlikely to fight again. Those likely to die of their wounds were given painkillers and made comfortable.

Civilian illness requires a different primary criterion – giving everyone a fair chance of a decent life.

With universal high quality health care rapidly becoming unaffordable, our society needs to re-focus our spending. The charts below, from the 2009 Annual Report of the Private Health Insurance Administration Council, demonstrate that most money is spent on hospital care of the aged, many of whom have little life expectancy, and those lives often of poor quality.

Death, at an advanced age and after a lengthy illness, is part of living. We must stop demanding that “everything be done” to prolong grandpa’s or grandma’s life. Let’s all give enduring power of guardianship to someone we trust, who will avoid this massive expenditure on futile treatment.

Let’s be fair to the young and middle-aged, who have not yet enjoyed their natural span.

The starter’s gun towards futile treatment is that phone call to the ambulance. To keep the old man or old woman, dying after a lengthy illness, comfortable and pain-free in their own bed, call in the GP and the district nursing service and, if necessary, the palliative care team. Avoid pulling that futile treatment trigger by phoning the ambulance.”