Some months ago, 89 year old Susan died alone in her Sydney nursing home at 1.30am. Susan had been living there for 13 years and had moved into the room next to my wife Trish’s mother Mollie a few days after Mollie’s husband Alf had died.
In nursing homes, couples are often housed in separate rooms as most rooms are big enough for only one person. So Alf slept in the room next to Mollie, and during the day they watched television together, sat in the garden on warm days and visited their children’s houses on weekends. They both loved the Balmain Tigers. They were inseparable and Mollie was bereft when her husband of over 50 years died.
Susan and Mollie rapidly soon became best friends, with Mollie telling her three daughters that Alf had sent an angel in Susan to take his place.
When Mollie died in 2014, Trish and her sisters regularly visited Susan. When she was still mobile, they’d go to a local café for lunch. They bought her an iPad and taught her to use it. Across the last six years, they were like the daughters she’d never had. I made her compilation music CDs from musicals and the 50s, which she played constantly.
Susan had only one other visitor, Enid, a woman of her age with whose family she had been unofficially fostered as a child. She was her next-of-kin. As she became more fragile with age, Susan became unable to leave the nursing home because of her greatly impaired mobility. She effectively was alone except for the weekly visits from Mollie’s daughters and less often, from Enid. Then COVID put an end to that for nearly two years.
As COVID restrictions relaxed, permission to visit again was given. Susan had aged a lot, her breathing was laboured and she was unable to move much at all without a frame. She ate like a sparrow and often talked about how there was nothing left for her to look forward to in life. More than once, she spoke about being “ready to go over the cliff”. Trish made her comfortable, held her hand and showed her photographs of our kids and grandkids.
About four weeks before she died, she was taken to a large Sydney hospital after frequent seizures. Oh mercy, this looks like it, Trish said, going in seven times before Susan finally died. Trish and Enid had daily calls and visited Susan twice together. Enid would interpret the slightest movement or sound as a good sign that Susan was perhaps recovering.
Susan soon became semi-conscious for days, fitting frequently as she sank neurologically, and being fed through a tube. Trish told Enid that Susan had often spoken of wanting to die. “I’m sure she would not have wanted to be artificially kept going, unconscious like this” she ventured a few times.
One day about two weeks in, Trish went to the hospital and the unconscious Susan was being was being washed by nurses. “She was like a skeleton. Murmuring incoherently, unable to speak. She’s like the living dead, and she’s still being fed. Why can’t they do something? She’s dying. The doctors and nurses have said this repeatedly!”
One day, a doctor visited while Enid was with Trish. Trish seized the moment and asked the doctor questions in front of Enid, knowing what they answers would be. “If Susan gets through this, is it likely she will be able to feed and dress herself? Will she be able to speak? Will she be able to get herself out of bed to the toilet? Will she be able to turn over easily in bed by herself?” The doctor said no to all of these.
Enid told Trish after the conversation “Susan will go when Susan chooses to go”.
A week before she died, Susan briefly regained consciousness. Trish went in to say goodbye. She could recognise her and tried to say “how are you”. With barely any energy left, she tried through tears to pull the tubes from her arms and the oxygen tube from her nose. She managed to say “get me out of here … home”.
She went back to the nursing home. Trish went to see her again. Susan again removed her oxygen line, and said “Am I dead?”
We talked every night about what to do. Not having next-of-kin status, despite being a frequent visitor and comforter, Trish had no legal standing in how she should be looked after in hospital. Susan couldn’t speak for herself, and Trish sensed very strongly that Enid, a Roman Catholic like Susan, was avoiding any talk about end of life.
Preparing an advanced directive was not something that Susan would probably been ever aware of. Trish sensed strongly that Enid was entirely uncomfortable about any discussion of what directions she might give the hospital and nursing home staff about end-of-life matters like sedation or withdrawing feeding. She may have felt this would have been profane and against her church’s doctrine.
Trish, with no legal status, was powerless to be an advocate for her interests. So Susan lived on for weeks when she expressed that she desperately to die.
I’ve no doubt that tonight, and every night across Australia there are dozens of elderly and dying people like Susan who have not lived in company with friends and relatives who actively encourage discussion about advance directives, let alone voluntary assisted dying. Many have few if any visitors. They are alone with no one speaking up for them. Only 14% of Australians have prepared advanced directives.
As the population ages, it is terribly important that a major awareness campaign be launched designed to inform people in their sentient final years about what their end-of-life options are. Any humane and compassionate society owes this to those who are alone and unsupported or who are under the legal governance of people who would just rather not talk about any of this.
Our clock radio wakes us a few minutes before the 6am ABC bulletin. On Saturday, a guest of the anglers’ program The Big Fish, was waxing lyrical about a catch where he described the length of a monster in centimetres but the weight in pounds. How bizarre is this I thought, and took to the wisdom of the internet to get other examples of imperial measure holdouts.
Here are some recalcitrants.
TV screens. “Wow, how big is that one? It’s a 65”
Birthweights “he was a big boy! 8lbs 13 oz!”
Height (especially in the very tall or very short “Collingwood ruckman Mason Cox towers at just under 7 feet” – not 211cm)
Tyre pressure in PSI pounds per square inch
Tyre width (man, 18” mag wheels!”
Wave height, especially when large
Boat and wind speed in knots
Rainfall in inches (generally now appended as “3 inches in the old system”
Altitude (“we’re cruising at 36,000 feet”)
Aviation relies on feet for altitude, nautical miles for distance, knots for true and relative airspeed. However, Ffuel weight, cargo weight passenger weight is in kilos. Standard descent pattern and timing for arrivals is approx 1000 feet per minute.
McDonalds quarter pounder
Penis length (“Mate, I’ve got 12” but I don’t use it as a rule”)
Australia commenced metrification in 1966, 59 years ago. The Metric Conversion Board was convened by an act of parliament in 1970, and dissolved in 1981, 44 years ago. Only three nations (that law unto itself the USA, and those beacons of progressive everything Myanmar and Liberia) still cling to imperial measures.
Fifty two percent of the Australian population are aged less than 40, and so were born after the formal drive to metrification ended. But the examples above (please notify me of more to add) show holdouts remain stubbornly common.
So why do we cling to these throw-backs? Some seem redolent with a sense that imperial measures carry a more elemental truth when it comes to serious shit talk about monster waves, biblical storms, robotic face-stuffing gluttony when it comes to hamburgers, and man-cave talk about cars, or wow factor in height or apocryphal locker-room penis length.
It’s as if when talk turns to excess, imperial trumps metric. Sewing instructions might just be market research that finds most of those who sew are older. Calories is enveloped in the guilt-ridden discourse about obsessing about weight loss, while joules sounds like all-too-difficult science chatter and seems destined to be the last throwback standing.
I can get my head around a 65” television description, but 165cm doesn’t mean that much while I’m totally comfortable with the meaning of my own height either way (180cm or 5’11”) but would get the times-up buzzer converting my weight (81kg into imperial: 12 stone 11 pounds). But 99% of most people would surely wince at being asked what a stone, a furlong, or a chain even meant.
Here’s an interesting piece on the history of the long-standing creep of ‘preventative’ into the realm of ‘preventive’
New Zealand’s on-line publication Stuff today published an agricultural swoosh at Australia’s recently announced new vaping regulations written by Ben Youdan, director of ASH, Action for Smokefree 2025.
If a Martian wanted an explanation of “sophistry”, Youdan’s article would be very useful. Let’s take a look through it, line by line.
Youdan: Vaping is far less harmful than smoking and is helping millions worldwide to quit the deadly habit.
Response: Oh really? Is that why 16 reviews, meta-analyses and consensus statements published since 2017 about the evidence on vaping in quitting uses language as “inconclusive, insufficient, weak or inadequate” to describe that research? And when it comes to “less harmful” what are we to make of the 2021 words of 15 former presidents of the Society for Research on Nicotine and Tobacco who stated “High-quality clinical and epidemiological data on vaping’s health effects are relatively sparse. There are no data on long-term health effects, reflecting the relative novelty of vaping and the rapid evolution of vaping products. Determining even short-term health effects in adults is difficult because most adult vapers are former or current smokers.” (my emphasis)
Youdan: The Australian ban is the worst kind of policy making, and lacks empathy for the 2.2 million Aussie adults who smoke.
Youdan: It will reduce their access to much less harmful alternatives. Especially when good access to alternatives are genuinely helping people, and likely reducing the future death toll of tobacco.
Response: Access to vapes will be available through any of 4,168 pharmacies through a prescription able to be issued by any of Australia’s 31,000 GPs.
Youdan: The bottom line is that this policy will prolong the life of the tobacco industry in Australia and shorten the life of the smoking population that will likely increase. This is not a policy we should adopt.
Response: So if it will prolong the life of the tobacco industry, please explain why it was that every tobacco company attacked the Australian prescription policy and wanted the “consumer” access model you have in Aotearoa/New Zealand? What do they know that you don’t know Ben?
Youdan: In Aotearoa between 2018 and 2021, smoking rates fell by an unprecedented 30%, and an almost unbelievable 40% for wāhine Māori.
The reason for such a large shift was a huge switch to vaping, as addicted smokers ditched cigarettes for good.
Our smoking rates fell below Australia’s for the first time in 2018, and since then the rate at which smoking is declining here is double theirs. It’s the same story for youth smoking.
There is no doubt that this huge impact on adult smoking in Aotearoa has been because people can get vapes where they get cigarettes; vaping is cheaper, better promoted and easier to buy than cigarettes.
Response: It’s obviously great that Aotearoa/New Zealand has seen these declines. But smoking rates in Australia fell faster than in Aotearoa/New Zealand in earlier periods when we often shared similar policies. So simplistic attribution of changes to single policies rather than to the synergistic historic interplay of all policies is tempting but is fraught with problems. Demographic and cultural differences in smoking especially make such comparisons difficult. Is Youdan suggesting that only vaping is responsible? What about Aotearoa/New Zealand having the world’s second most expensive cigarettes?
Here’s a salutary graph from Britain on the same issue.
Youdan: Australia, on the other hand, has just proposed a policy that essentially bans the sale of vapes outside a medical prescription model – but at the same time leaves cigarettes in every petrol station, supermarket, dairy and convenience store.
Could the tobacco industry ask for any better gift than a government-sanctioned monopoly for cigarettes, by far the deadliest nicotine products.
Response: Again, how very odd then that every transnational tobacco company is implacably opposed to Australia’s prescription access scheme. If it was going to be such a gift to them, they would all be cheering it on, surely?
Youdan: For the thousands of Australian vapers who have quit smoking, their access to safer products is about to be cut off, leaving them surrounded only by cigarettes.
Response: Cut off? Just like all other prescribed drugs are cut off to all Australians who in 2020-2021 got 314.6 million scripts filled?
Youdan: It will be a miracle if smoking rates don’t increase In Australia.
People celebrating this pro-smoking policy argue that prescription-only access to vapes works as a safer way to access treatments. This assumes that we live in a fair world and ignores the reality that smoking rates are highest in low-income populations, rural populations and especially in Aboriginal and Torres Strait Islander communities.
These groups are already under-prescribed for existing drugs, and most likely to be failed by the new proposals.
Response: Now why would ASH be worried about kids taking up vaping when it argues that kids’ vaping is driving down their smoking and that vaping is near enough as benign as inhaling steam in a shower? Do they think that possible vaping harms occur to the under 18s, but that once you turn 18, our bodies are just fine getting an average 500 point-blank chemical vapour bastings a day, year after year?
Youdan: However, policies of prohibition don’t work. Despite having banned nicotine vapes in Australia since 2021, a recent report has suggested almost 14% of 15-17 year-old Australians vape regularly, the same as New Zealand.
These young vapers are already using illicit products, as they mostly vape nicotine despite it being illegal.
Response: And how has this situation arisen? If vapes are to be “prohibited” in Australia, then by the same reasoning all prescribed drugs are also prohibited. You know that makes sense. The “ban” since 2021 was gutted by the actions of conservative politicians, egged on by pro-vaping groups and Big Tobacco, by overturning the original ban on vape imports. These groups now regularly talk about Australia’s failed prescription policy when their opposition to it assisted that failure.
Youdan: The vapes they use lack quality standards, or clear provenance. A situation that is already more harmful than in a legitimate vape market like Aotearoa.
Response: This is eerily reminiscent of a card often played by Big Tobacco about smuggled cigarettes: they are much more deadly than our “pure” factory made cigarettes. You know, the ones that kill only 2 in 3 long term users.
Youdan: Australian campaigners have claimed that there is a generation of kids addicted to nicotine in vapes. In which case where will these young people turn to cope when this ban happens? Unlucky for them, Australia’s Government is making sure cigarettes can still be sold everywhere.
Response: Most nicotine addicts don’t need to “turn to” anyone when they finally quit. They quit unaided. Those who really struggle can try prescribed meds … or has ASH NZ now walked away from them? “Making sure …” Yes that’s why every single tobacco control policy fought and won in Australia since the early 1970s was deeply opposed by Big Tobacco. They just love what Australian governments have done to them across 50 years. But yes, Australian tobacco control agencies are very envious of Aotearoa/New Zealand’s policies of dramatically reducing tobacco access, true nicotine delivery and the eventual phase out of sales. We’d be very happy to copy those policies.
Youdan: As much as we don’t want kids to vape – we really don’t want them to smoke. To date we’ve seen no evidence youth vaping leads to smoking, but the Australian proposals might change that.
Response: There are none so blind as those who will not see. There is huge evidence that kids who vape are much more likely to smoke later, even when well known predictors of propensity to smoke are controlled for in analyses.
Youdan: More people are quitting smoking than ever before in Aotearoa, nudged by progressive anti-smoking policy, and given the availability of vaping as a more accessible and cheaper way to manage nicotine withdrawal.
Our youth vaping rates increased a lot until 2021, when the Government finally put some regulation and rules in place around vaping.
Since then, the rate of increase has slowed, and the number who have tried vaping has even decreased. The problem with New Zealand’s policy is not that it’s too permissive, but that it came too late.
We can reverse the trend, and in 2022 we saw the first decrease in youth vaping recorded in the ASH year 10 survey.
“Daily vaping increased a statistically significant amount for Māori participants (19.1% in 2021 to 21.7 in 2022), in particular for Māori girls (21.3% to 25.2%). There were no statistically significant changes in daily vaping rates for other groups when analysed by ethnicity and by ethnicity & gender.” (bolding my emphasis)
If ASH are worried about health inequalities, they should be deeply alarmed by this evidence from their own survey.
Youdan: We need to do more though. ASH urges the government to step up and resource evidence-based approaches around youth education, support to quit vaping, and to help schools battling at the front line with little or no help.
We’d also like to see better enforcement of sales to minors, an increase of the selling age to 21, reduced appeal of vape marketing, and cessation of the rapid rise of disposables.
Response: Oh dear. Ben would know well that terribly concerned statements about children smoking or vaping and calls for more education, crackdowns on selling to minors, and calls for marketing that can magically be seen by adults but not by children are all cynical, fingers-crossed calls from the Big Tobacco and Big Vape advocacy playbooks. These are industries whose long term survival and business models depend on robust uptake of smoking and vaping by kids.
Why not stock vapes in school tuck shops if they are so harmless and wonderful at reducing smoking? Are you not telling us something here Ben?
Youdan: We have decades of experience in drug education and harm reduction with kids, and lessons about what works and what doesn’t.
We need to apply this experience, not follow the Australians swinging wildly in the dark and hoping to hit the target.
Response: Australia has no experience in effective tobacco control? Oh please …
Youdan: It will reduce their access to much less harmful alternatives. Especially when good access to alternatives are genuinely helping people, and likely reducing the future death toll of tobacco.
Response: It will dramatically reduce access to vapes by kids and by “recreational” vapers – many who have never smoked or are smokers who are not trying to quit. Death rates from tobacco caused disease have been dramatically reducing since the 1980s, thanks to the “wild swinging in the dark” Australia and others nations have engaged in.
The bottom line is that this policy will prolong the life of the tobacco industry in Australia and shorten the life of the smoking population that will likely increase. This is not a policy we should adopt.
Response: The tobacco industry is on life support in Australia, with the switch off not far away. All tobacco growing and manufacturing has long gone and long ago the industry described Australia “as one of the darkest markets in the world”. The global tobacco industry is climbing over itself to stop innovations like plain packs that started here. They are now doing the same with prescription vaping access. What should that tell us all?
Simon Chapman AO 