A Better End Must Be Part of Palliative Care

This article appeared in the West Australian, 18 February 2008.

When Bob Brown announced his plan to introduce new legislation to revive voluntary euthanasia in the Northern Territory, the Territory’s Chief Minister, Paul Henderson, was miffed that he hadn’t been consulted. He suggested Territorians might have changed their views on the issue since the voluntary euthanasia legislation was enacted back in 1995.

That’s extremely unlikely. Polls show a steady increase since the 1980s in the number of Australians supporting a legal system of voluntary euthanasia, with over 80 per cent now in favour.

It’s easy to see why. Almost every family in Australia has had some experience of the dreadful suffering that is taking place due to our grossly inadequate system for dealing with the end of life. Nothing else attracts the overwhelming response I have received when writing on the issue. Family members talk with such passion of their sorrow at being unable to prevent loved ones from suffering miserably in their final days, often people with living wills who were determined to avoid such a gruesome end, but our system let them down.

One woman whose mother died nearly two years ago wrote of still waking up sweating at night, overwhelmed by guilt for “not having the guts to take the law into my own hands and hasten her end”. Her mother had a stroke. “She would have committed suicide if she had known her stroke would leave her completely paralysed in every part of her body, deaf and blind and worst of all, with no hope of an easy death,” the daughter said. Unfortunately, the mother’s stroke just happened out of the blue and the younger woman watched helplessly as her mother suffered through long, miserable final months.

It is hard to think of another issue where the wishes of such an overwhelming majority are so consistently being overruled. How is it possible that we allow the small numbers of noisy anti-euthanasia campaigners to consistently hoodwink our wimpish politicians into running scared on the issue? Just look at the blathering from Mr Henderson. He suggested the view of the Territory Parliament is likely to be different now because “palliative care has improved” since the voluntary euthanasia legislation was enacted.

When are politicians going to admit the palliative care argument just doesn’t hack it? If they actually did their homework and looked at what palliative care experts are now saying, they’d realise this care isn’t the answer to dealing with all end-of-life issues. Yes, palliative care is improving. The dedicated, hard-working practitioners of this wonderful service do relieve suffering for a lot of people. But not all.

There’s a South Australian study showing palliative care failed to relieve pain in a quarter of patients with terminal cancer and failed to help a third who had difficult breathing and 57 per cent of those with nausea and vomiting. It’s not just about pain but about once strong, independent people forced to spend their last days helpless, dependent and miserable.

Finally now we are seeing some public acknowledgement of these limitations. Palliative Care Australia has issued a position statement recognising that “complete relief of suffering is not always possible, even with optimal palliative care” and that some people “rationally and consistently request deliberate ending of life”. The idea that palliative care can relieve all suffering associated with death and dying is a flawed approach, says Michael Ashby, the former professor of palliative care at Monash University. Overseas we are seeing similar shifts from palliative care bodies in countries such as the US, Belgium, Switzerland and Germany. In Oregon, physician-assisted suicide is legalised and is now an accepted component of palliative care practice.

That’s the point really. Well-functioning legal systems do exist overseas which offer physician-assisted euthanasia as part of a carefully run, fully monitored system based around palliative care.

That’s what Australians have been asking for. Perhaps some of the great thinkers gathered together for Kevin Rudd’s ideas summit will be willing to lobby for a proper examination of these alternative systems so we can not only improve the qualities of our lives but offer real hope for a better end.