“Most people aren’t scared of death, they’re scared of the process of dying,” he said. 

“If you can assure someone they will die comfortably, surrounded by their family, most people are happy with that. What they’re frightened of is dying in pain or scared.”

Dr Fletcher and unit co-ordinator Meagan Adams work with patients and their families to organise end of life directives dictating what kinds of treatments they do or don’t consent to.

Without such directives, patients are at risk of dying traumatic and frightening deaths, with the dying process prolonged by painful surgeries and invasive treatments.

The burden doesn’t just fall with patients and their families, it takes a heavy toll on medical workers as well.

“It’s the biggest source of burnout for nursing staff,” Dr Fletcher said.

“They’re there, they see what people go through and they don’t want to put people through that pain. As a doctor, until I’m convinced something won’t work or I’m told by a patient or their family to stop, I’m obliged to keep going. We’re faced with that almost every day and it’s going to get worse with an ageing population.”

Dr Fletcher became interested in advanced care planning after he treated a critically ill patient choppered in from St Arnaud in the middle of the night. When the patient’s family arrived, they said the patient would never had wanted such invasive treatment to prolong his life.

“I thought, ‘there’s a paramedic who has flow in the middle of the night which is dangerous, the family has driven in the night which is dangerous, we’ve had to kick people out of the ICU to treat this person; this is crazy’,” Dr Fletcher said.

“He should have died in St Arnaud five hours earlier and the paramedic could’ve been having scones in Essendon. No one asked the patient what he wanted.”

Ms Adams said her passion for advanced care planning was in part sparked by watching her own family’s struggle with the end of her grandmother’s life.

“Even though Nanna was competent until the day she died, we still didn’t know whether keeping her in the nursing home was what she really wanted. It’s a very burdensome thing for children to have to do,” she said.

Ms Adams encourages people facing the end of their lives to think about what they value most in life.

“That could be the ability to talk to their loved ones or know who is in the room or look after themselves,” she said. 

“If you weren’t going to be able to do those things, what would the goals of your medical treatment be? Would it be to prolong your life or would it be to keep you comfortable and allow the disease to progress and for us not to intervene?”

Dr Fletcher said he was “blown away” by most people’s willingness to speak about death when prompted.

“When I started doing this, I was nervous about talking to these people,” he said.

“But as soon as you did, they’d say ‘thank God you brought this up; I’ve been meaning to talk about it for years.’

“It gives them control and certainty. Most people say it’s a big weight off their shoulders. There mightn’t be certainty about the outcome, but there is certainty about what won’t happen, which is usually the real stress.”

Ms Adams said it was important for all people - old and young - to speak to their families about their final wishes and identify a medical enduring power of attorney.

“About 15 per cent of deaths are people dying young and healthy,” she said.

“Every night you look on the news and see a young kid who has had a fight in a nightclub, hit their head on the concrete and ended up with a brain injury.

“That’s a very big proportion of the population. It’s important to think about how your life would change from being fit and healthy and independent to dealing with a brain injury for the rest of your life or having kidney disease and needing dialysis for the rest of your life.”

Find out more about advanced care planning here or speak to your GP.