A rural doctor reflects

Like many rural doctors, Dr Jonathan Ramachenderan has dual roles. He works both as a palliative care GP with the Great Southern Palliative Care Service in Albany and also provides anaesthetic services at Albany Health Campus, in the southern region of Western Australia.

Supporting patients and families to have tough conversations

Jonathan is a passionate and knowledgeable advocate for advance care planning in his community. He gains satisfaction in helping his patients navigate the process, which can at first appear daunting.

“What I am thanked for most in my work is facilitating (advance care planning) conversations between patients and their families. These conversations are not about death, but about life. It’s not about how we want to die, but how we want to live,” explains Jonathan.

“I enjoy working with patients and families and helping bring peace and clarity during, at times, difficult circumstances. Research tells us that families who communicate openly about the end of life and around their goals of care, have a more positive experience as their loved one enters their last days."  

An unforgettable woman and a dignified end

During his medical career, Jonathan has encountered many patients, but none have had such a profound impact as an unforgettable 85 year woman.

“She was my first patient during my first week as a palliative care GP. I was struck by her openness and peace as she approached her final days, which ultimately became a celebration of her life.”

The day before the woman died, she grabbed his hand and said, “Jonathan, I’ve told my friends about you and that they need to see this new GP”.

"I had only known her for four days but I will remember her kindness forever and the way she was clear about receiving comfort care and gathering her family in her final days.”

The need for greater awareness

Too frequently, Jonathan has witnessed the avoidance of advance care planning conversations and the aftermath. He believes that communication today can go a long way in preventing heartache and non-beneficial and unnecessary medical treatment tomorrow.

“Unfortunately, many of the stories that remain with me as a doctor are those that didn’t unfold well for patients and their families. The single factor in all of these cases was lack of communication or a failure to engage in advance care planning."

Dispelling the myths

“I think the biggest barrier we face is the false belief that in talking about death we are giving up.”

“We live in a world that celebrates life, youth and achievement. Talking about our end of life is often seen as dark and depressing, however in reality it’s very empowering.”

“Unfortunately, many of the stories that remain with me as a doctor are those that didn’t unfold well for patients and their families. The single factor in all of these cases was lack of communication or a failure to engage in advance care planning."

Some advice for getting started

Jonathan believes that a good introduction to advance care planning is to start with two simple questions:

  1. How would you like to be remembered on your last day
  2. What care would you like to receive if you could not speak for yourself?

“My advice would be to see your local GP, someone who knows you and can help facilitate the conversation.”

Jonathan is also keen to highlight that any significant change is your health should trigger beginning or following up advance care planning conversations. And it’s important to remember advance care directives can change with your clinical journey.

Live for today. Plan for tomorrow

His work in advance care planning has influenced Jonathan’s attitude to life and living. He has experienced the empowerment and peace of mind that comes with completing his own advance care planning.

“I’ve made clear what’s important to me and that involves keeping me comfortable, avoiding any non-beneficial treatments and gathering my boys and family around.”

Jonathan finds it both sobering yet empowering to fully embrace that our days are finite.

His philosophy towards life is best summed up by one of his favourite authors, Ann Voskamp, who wrote, “We must learn to live fully, so we are fully ready to die”.


Advance care planning requirements differ across Australia. Be sure to refer to the advance care planning forms and documentation relevant to your state or territory.