Snippets of evidence for cultural change

FOR many years I had thought that the title of my sister’s PhD in statistics was Rumour spreading in bees and spread the idea widely before she corrected my misapprehension. I became a figure of family mirth and derision when she told me that actually it was titled Rumour spreading and disease.

The correct name did not make the PhD any more comprehensible to me as, apart from the title, it was mostly equations. Anyway, I can imagine that the relationship between rumour spreading and communication between bees could also be modelled mathematically.

However, leaving aside this simple messaging error, the transmission and integration of new ideas is the means by which our culture changes, whether our evolving memes are those of religious belief systems, football team supporters or advance care planning.

For the past few years, there has been a growing movement to encourage the beliefs and skills that support people to engage in advance care planning as a routine part of everyday life.

Clearly this is a long term project, but it is easy to become dispirited at times by a seeming lack of uptake and integration of these memes, both by clinicians and the community at large. The evolution of culture is manifest as millions of conversations and their consequence, as progressive changes in the sum of all our individual behaviours. At times, progress can slide unnoticed into our lives.

Early one morning a few weeks ago, I went for a walk up and down Castle Hill here in Townsville, as I do frequently. I was not alone, for every day many hundreds of people of all ages, shapes and sizes ascend one of the many rocky tracks or amble up the road. Some of us are pensive and solitary individuals taking the opportunity to ruminate on the meaning of life, others walk with friends, or exercise in groups harassed by their boot-camp trainers. At the top, there is often a queue for the water cooler before we enjoy a leisurely stroll back down. Many of the faces are familiar, although most do not have names.

Anyway, back to my steamy tropical morning’s exercise. As I strode along on the way down, I overtook two late-middle-aged gentlemen (about my age). As I passed, I heard one say to the other:

“Anyway, we really need to do it for the kids.”

“Yes,” came the reply.

Then the sound of the wind in the trees drowned their voices temporarily, or perhaps they were just thinking.

After a pause:

“Then they will know that it’s okay for them to pull the plug.”

Another pause:

“And they will be able to get their hands on our debt much sooner!”

Roars of laughter.

At that point, I smiled to myself as you do when a pleasant thought emerges while you are enjoying a solitary walk (people going the other way may well speculate about what it is that makes you happy).

Cultural change is the consequence of a contagion of ideas rippling outwards from conversations that implant an idea into the minds of our families, friends, colleagues and patients.

People are starting to talk about planning for the end of their life, even while healthy and still well able to walk up a big, steep hill. Real cultural change is happening out there in the world where people live and perhaps, for healthy people, years or decades before the conversations bear fruit. If one old guy out for a walk is telling another that they both need to undertake advance care planning, then that for me is sufficient evidence that the buzz of our rumour mongering is working.

Associate Professor Will Cairns is a palliative medicine specialist based at The Townsville Hospital and author of the eBook Death Rules – how death shapes life on earth, and what it means for us.

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