Euthanasia no substitute for palliative care
Associate Professor Richard Chye is director of palliative care at St Vincent’s Hospital Sydney and a member of Palliative Care Australia’s Board.
The first person I had to tell they were dying was my father, I’ll never forget it. He was 46 and suffering from kidney cancer; I was a 20-something medical student who had to read through my text books to find out what was happening to him.
Not one doctor had told my dad he was going to die. Not one had told him when it might happen. Not one had helped him prepare psychologically for what was happening to him.
He looked to me for answers, I looked to my textbooks. The answers were confronting and didn’t include any advice about how to deliver this kind of news.
I had to tell my dad that, based on my research, he had maybe months. He thanked me.
That was when my career took a dramatic turn. Previously determined to become a cardiologist, I refocused and set my sights on working with cancer patients and eventually to palliative care more than 20 years ago.
During that time the euthanasia debate has been raised several times, as it was again this week.
Advocates of euthanasia are concerned about Australians dying in unbearable pain. On this issue, I can relate to them. Absolutely, I am concerned too.
I can also tell you that complex pain can be temporary and treated. Treated pain does not mean free of pain; it means that patients and families can still function and enjoy their limited time. Palliative care can help overcome it and, when it does, people come through the other side grateful for the days or weeks they have to patch up relationships with siblings, parents or friends, or to spend valuable minutes with their grandchildren.
Most Australians choose not to engage with death until we absolutely have to; that’s understandable. I have a young patient who “hid” her illness from family and friends, and now that she is close to the end, she has regretted not having the chance to resolve many things with her family but, more importantly, she has not been able to help her family plan for the future without her.
Because we avoid death, it is hard to know what we might want when confronted by its reality. When considering death in the abstract, it might seem euthanasia is a good way for Australia to head, but I am concerned we are too caught up with our “right” to die, while not investing in the system that helps us live as well as possible before we die.
I agree there are problems with how Australians are dying, but I think access to good-quality palliative care can change that. Australians want to die at home but need better support services to do so. Carers need respite and your postcode often determines access to services. These are the rights we are currently denied. This is what we should be getting up in arms about.
Dying is much more complex than just ordering a dose of pills and flicking a switch. And the more we ignore it as a society, the more appealing an “off” switch might seem. Before we consider flicking a switch, we might do well to invest more in giving people more quality time. That’s what palliative care does. To do that, we need to educate doctors about pain management and when and how they can refer people to specialist palliative care.
More Australians die in pain because of lack of access to palliative care, not because of palliative care. Euthanasia is not a substitute for palliative care. Good-quality palliative care is not going to work for everyone, just as heart surgery is not 100 per cent successful. But for the majority, a palliative care experience is a good one.
Doctors need to take some responsibility as well. Palliative care is a small part of general medical training; we tend to focus on the saving and not enough on the right time to let someone go. Palliative care is not only resisted by patients who see it as an end game, but their doctors, who see it as a failure. It is neither of those. In palliative care we often help patients and their families come to terms with what is happening to them, perhaps we need to sit with their doctors as well.
We all need to talk more about death being a natural part of life. Maybe then we will be better equipped to enable people who are dying to get the best out of any time they have left.
The best chance they have of achieving that best-case scenario, is giving them access to good-quality palliative care. Euthanasia is a very complex ethical debate that should happen well after we have achieved that.
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