Spoiler alert – we are all going to die.

However, we push the inevitability of death deep into our subconscious unless we know someone with severe health issues.

Sometimes an eager researcher with a clipboard might push the issue of death back into our conscious mind by asking us about how we want to die. When we are forced to think about our death, we tend to be very clear about where we want to die. At home!

We are keen to avoid a hospital death and prefer to die in our own home, ideally in the presence of our loved ones or in our sleep.

Australian data says 70 per cent of us want to die at home.

Do we get our last wish granted? How many of us end up dying in our own home? Well, less than 15 per cent of Australians die at home, according to official ABS data.

The more remote our place of residence, and the farther we are away from a hospital, the more likely we are to die at home rather than in a hospital. It is therefore no surprise that more Indigenous Australians (22 per cent) who are more likely to live in remote areas, die at home than non-Indigenous Australians (13 per cent).

Young deaths are more likely to occur at home. Accidental deaths through substance abuse and suicides play a role here. The much more common death occurs in old age and these deaths occur in hospitals or aged care facilities.

I’d argue that the main reason we aren’t dying where we want to die has to do with our severe discomfort with the topic. It’s simply uncomfortable to think about our own death, and discussing death with our loved ones is even harder.

In your stock-standard, male-female couple, it tends to be the husband that dies first since she is four years younger than her husband and has a longer life expectancy. This means there is a bit of a gender angle here, too. Women, therefore, more frequently need to decide if and when life-prolonging procedures should be withheld. What would my partner want?

You better have discussed these scenarios in great detail prior.

A crucial read on the topic, Death Interrupted by Blair Bigham, discusses the Canadian system but is still very applicable to us in Australia. We must view death in the context of modern medical technology.

Modern medicine is pretty darn good at keeping us alive.

Unfortunately, that sometimes comes at the expense of our quality of life, prolonging suffering rather than gifting us valuable additional time on earth.

Think of this as the medicalisation of death. Our final weeks, months, or even years become but a series of medical decisions rather than a natural process.

Since death occurs mostly out of sight, we became distanced from traditional understandings of dying as a natural end to human life. Family members can easily be overwhelmed and confused by the choices they must make on behalf of their loved ones. When should we withdraw treatment? That’s a timeless medical dilemma.

In the absence of clear wishes from the patient, families and doctors face serious ethical challenges fraught with uncertainty. The line between life-sustaining care and prolonging death is terribly blurry.

The dying person might be subjected to invasive procedures with little benefit, besides allowing families and doctors to claim that they’ve done everything they possibly could’ve done.

For us to reimagine end-of-life care we must put a heavier focus on the patient’s quality of life rather than the patient’s lack of death.

The patient’s autonomy might be much better served in a palliative care setting.

This brings us back to the role of narratives about death. If we acknowledged death as a natural part of life, rather than something we must fight at all costs, this would allow us to die in our homes rather than in sterile hospital beds.

How likely is it that we change our attitudes towards death significantly? Not that unlikely, I’d say. The next big demographic wave of death will start in less than a decade when Baby Boomers (born 1946-63) leave this world behind. So far, Baby Boomers transformed and reimagined every stage of the lifecycle they lived through. In the coming decade they will transform retirement, aged care, and death.

Baby Boomers will want to be in control of their own destiny.

Expect big changes in euthanasia laws. Boomers will also find ways to lock in their wishes regarding life-prolonging care, in a sense taking power away from families and doctors. A patient-driven death will be much more common.

To be terribly blunt, the medical system will welcome such changes as the last six months of a person’s life tend to account for about a quarter of their life-time medical expenditure. A patient-driven approach to death will ensure that doctors don’t fear negative consequences when they don’t prolong life as much as technically possible, that family members are unburdened from the decisions whether or not to “pull the plug”, and the healthcare system needs to spend less money.

As a consequence, I would expect ABS data in a decade to report a higher share of deaths at home.

Demographer Simon Kuestenmacher is a co-founder of The Demographics Group. His columns, media commentary and public speaking focus on current socio-demographic trends and how these impact Australia. His latest book aims to awaken the love of maps and data in young readers. Follow Simon on Twitter (X), Facebook or LinkedIn for daily data insights in short format.