Vital reforms to end-of-life care are essential to assist the majority of Australians who want to die ‘a good death’ at home.

A Grattan Institute perspective published in the Medical Journal of Australia, based on its earlier Dying Well report, states dying has become highly institutionalised in Australia, with 54 per cent of people dying in hospitals and 32 per cent in aged care.

Professors Hal Swerissen and Stephen Duckett state only 14 per cent of people die at home in Australia despite up to 70 per cent of people preferring a non-institutionalised death.

“Dying is not discussed, and we are not taking the opportunity to help people plan and prepare for a good death,” they write.

“As a result, many experience a disconnected, confusing and distressing array of services, interventions and relationships with health professionals when they are dying.”


Professors Swerissen and Duckett recommend a public education campaign that encourages people to consider, discuss and document their end-of-life preferences with their families and appropriate health care professionals.

They propose trigger points for mandatory discussions about end-of-life care, including during health assessments for people aged over 75, for all aged care residents and high-needs recipients of home-based care packages, and for all hospital inpatients who are likely to die within a year.

Measures must be introduced to ensure patients’ plans are implemented, while they also suggest health professionals are in the best position to initiate the discussion.

“They must shift their focus from prevention, cure and rehabilitation at appropriate points in time if these conversations are to occur.

“It is therefore important that it becomes normal and expected practice for health professionals to discuss and plan for end-of-life with their patients when it is appropriate.”

Professors Swerissen and Duckett say improvements are needed to better coordinate end-of-life care while legislative frameworks and guidelines for advance care plans must change.

“They should include clear mechanisms for assigning specific responsibility to health care professionals to coordinate and implement plans when people enter end-of-life care.”


A major increase in the availability of community-based palliative care will assist carers, who often struggle to manage a crisis episode which results in many people at the end of their lives being admitted to hospitals via emergency departments.

Professors Swerissen and Duckett estimate enabling 30 per cent of Australians to die at home would cost $241 million and a national education campaign would cost $10 million.

They state a reduced demand for hospital and aged care would leave an overall net cost of $84 million.