Feature
Will palliative care and voluntary assisted dying clash – or collaborate?
As voluntary assisted dying becomes legal for a quarter of all Australians later this year, experts say that well-funded palliative care will only become more important – not less.
An Australian report found the palliative care sector had actually benefitted in overseas jurisdictions where assisted dying legislation had been passed. (Images: Georgios Kefalas, Mick Tsikas)
From mid-June, suffering Victorians at the end of life who meet strict eligibility criteria will be able to seek voluntary assisted dying via a substance causing death.
The move is not insignificant, as Victoria accounts for 25% of Australia’s population. And such a shift in policy begs the question, will palliative care and voluntary assisted dying clash or collaborate?
A new report commissioned by Palliative Care Australia found that the palliative care sector had actually benefitted in overseas jurisdictions where assisted dying legislation had been passed.
‘[There is] no evidence to suggest that the palliative care sectors were adversely impacted by the introduction of the legislation,’ the report states.
‘If anything, in jurisdictions where assisted dying is available, the palliative care sector has further advanced.’
The report is designed to help Palliative Care Australia review its position on euthanasia and assisted dying before the first Victorians can seek assistance dying.
Palliative care specialist Dr Nicola Morgan told newsGP assisted dying will not replace the need for palliative care.
‘Palliative care is not against the debate around euthanasia, because where debates have happened palliative care starts to improve,’ she said. ‘That’s because when people realise the alternative [to voluntary assisted dying] is not crash hot, governments look at funding palliative care better.
‘We have to have a viable alternative, and good palliative care in the community requires improved funding.
‘People think if you’ve got euthanasia available, they can get it. But many people are probably not going to ask for it at the right time. People who come to my ward at the end of the cancer journey are not going to be covered by euthanasia. It’s a rigorous process.’
Victoria has a number of safeguards for its voluntary assisted dying model:
- Only adults with decision making capacity, who are suffering and have an incurable, advanced and progressive disease, illness or medical condition that is likely to cause death within six months (or 12 months for people with neurodegenerative conditions) can access the scheme.
- A person may only access voluntary assisted dying if they meet all of the strict eligibility criteria, make three clear requests and have two independent medical assessments that determine they are eligible.
- The request must always be initiated by the person themselves, with health practitioners treating the person who raise the issue subject to unprofessional conduct investigations.
‘When you come to the hospital in the last week of life, you won’t be eligible. Your mother suffering from dementia in a nursing home, she won’t be able to get it,’ Dr Morgan said.
The Palliative Care Australia report states that ‘implementation of legislation may drive a stronger focus on upholding patient choice and autonomy, and there may be opportunities to introduce system improvements in palliative care, either as a direct or indirect consequence of the planned implementation of assisted dying’.
Dr Morgan’s husband, Associate Professor Mark Morgan – who is Chair of the RACGP’s Expert Committee – Quality Care (REC–QC) – told
newsGP he would strongly advocate for high-quality palliative care in tandem with moves to introduce voluntary assisted dying.
Associate Professor Mark Morgan said he would advocate for high-quality palliative care in conjunction with moves to introduce voluntary assisted dying.
In a 2017
Medical Journal of Australia article, Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, Professor Ezekiel Emanuel, stated assisted dying and euthanasia would only help a tiny minority of patients.
‘Euthanasia and PAS [physician-assisted suicide] do not solve the problem of inadequate symptom management or improving palliative care. These interventions are for the 1% not the 99% of dying patients,’ he wrote.
‘We should end the focus on the media frenzy about euthanasia and PAS as if it were the panacea to improving end-of-life care. Instead, we need to focus on improving the care of most of the patients who are dying and need optimal symptom management at home.’
GP Dr Horst Herb, who
gave qualified support of euthanasia last year, told
newsGP palliative care and euthanasia are complementary.
Dr Herb worked for decades as the only GP in Dorrigo, inland from Coffs Harbour in NSW, and provided palliative care to many long-term patients. But he would have been prepared to help them die if it were legal and if he knew the patient well.
‘I’d need to be very sure this is something the patient has thought long and hard about, that this fits with what the patient usually would decide or act upon,’ he said. ‘That’s impossible to do if you don’t know the patient well, to know if it’s out of character or not.
‘With [long-term] patients where I’m confident I understand where they are coming from, I would be very happy to be involved. I wouldn’t be happy to treat a patient I’m not familiar with, as it would be hard to understand if it was just the spur of the moment.’
‘Palliative care has always been neglected. I hope [assisted dying debates] will bring funding to palliative care.
‘Most people will still die with palliative care. Euthanasia will be the minority, for many reasons. One key reason is inertia. Choosing the right time and making that decision [for assisted dying] is very difficult, so many will instead die a natural death.’
Other states may soon follow Victoria, with
Western Australia to introduce a bill next year and
Queensland to establish an inquiry considering assisted dying.
New South Wales and
Tasmania have voted down voluntary assisted dying legislation. Efforts last year to allow the
Northern Territory and the Australian Capital Territory to be able to pass their own legislation were voted down.
The Northern Territory was the first jurisdiction in Australia to pass euthanasia legislation in 1995, but the laws were overturned by the Federal Government less than a year later.
Four people ended their lives with medical assistance during that period.
euthanasia palliative care voluntary assisted dying
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