Care for Sick Need Not be a Fight to the Death
By Nigel Gray The AGE, 14 April, 1995
‘There are undoubtedly situations where patients are not getting what they want.’ In the euthanasia debate, we should not lose sight of the potential of palliative care to help terminal patients through their suffering, Nigel Gray writes.
These columns have revealed a diversity of views on euthanasia that will obviously not meet the Premier, Mr Kennett’s, stated requirements for a consensus before the law is changed. However, there is a great deal of consensus.
Everybody is agreed that patients should die where they like, with whom they like, and in comfort. Not everybody is agreed that they should have the right to say when. This, not surprisingly, engenders debate.
Victorian law is already pretty good. Patients have the right to refuse further medical treatment. Given this instruction, doctors have the right to give suitable palliative care and wait for nature to take its course. This is legal and is not called euthanasia.
It is, in Victoria, possible to make dying patients comfortable and this is particularly the case with cancer. The process can be handled by a competent general practitioner or other suitable medical attendants, with family, friends and nursing support.
Euthanasia is often discussed in relation to cancer but more by the press than the patients. In fact, cancer is an excellent example of the rapid progress by which the control of pain and the provision of good palliative care is available to most patients.
Australians fear cancer more than any other illness, according to a survey by the Anti-Cancer Council’s behavioral science unit. There are many reasons for this but an important one is that, for many people, experience with cancer care occurred with parents or in the ‘60s, ‘70s or early ‘80s before the present era of comprehensive, often home- based volunteer-supported palliative care.
Patients need no longer die in isolation from family and friends.
Dying cancer patients can expect expert assessment of pain and almost complete relief from it. A wide variety of support techniques and support groups is available.
Cancer care is obviously not perfect and we may still make mistakes, but neither the law nor provision of resources are great barriers to cancer care. In 1984, the Anti-Cancer Council, through its Webster report, set some of the standards for palliative care in Victoria. The key features continue today. They are: 24-hour access to medical and nursing care; support and respite for caregivers; access to professional counselling; and community services offering practical help in the home (meals on wheels, occupational therapy, physical therapy equipment and home-care nursing).
This is not just a wish list for people dying with cancer; it is a reality. Great strides have been made in pain management and these services are provided in most cases. The Victorian Government’s Health and Community Services Department is now examining ways of extending these palliative care services to remote areas.
This raises an important issue for people involved in the euthanasia debate. Why are these excellent palliative care services primarily available to people with cancer? What we know in cancer could and should be used in the treatment and pain control of many other diseases.
A constructive initiative in this debate would be research into ways of extending the cancer palliative care model into all areas of medical practice and particularly to patients with other chronic and progressive disease. Without this palliative care model, people who are suffering are not given quality of life or death.
Broadening our palliative care services to help those with progressive diseases (motor neurone disease, for instance) ought not to be impossible.
The dilemma arises most with rational patients, suffering stable but persistent illness (severe stroke, for instance) who want the right to die and the help to achieve it. Many of our more literal thinkers want the law changed for this purpose, as do some patients, to specifically permit active euthanasia. To those with this philosophical view, the anti-euthanasia groups are interfering with their autonomy and freedom which is, of course, true. There are undoubtedly situations where patients are not getting what they want.
Legal, active euthanasia will be a complex and bureaucratic process involving laws, regulations, multiple opinions, certificates and signatures. Palliative care is not like this.
One cannot object to the right of those wanting legal change to bring about euthanasia to pursue their cause. But I would hate to lose sight of the main target widespread use of the techniques and laws we already have.
These comments illustrate why the Anti-Cancer Council of Victoria is seriously neutral in this debate. We have great diversity of view in our ranks of voluntary advisers. However, lack of unanimity is no excuse for not trying to do what we are already able to do, better and for more patients, while the debate continues.
Nigel Gray is director of the Anti-Cancer Council of Victoria.