Palliative sedation a 'peaceful way to die'

PEACEFUL END: Annemie Verschuren before her illness.
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PEACEFUL END: Annemie Verschuren before her illness.

Dying peacefully in your sleep is often touted as the way to go. DEIDRE MUSSEN reports on being put to sleep until you die, called palliative sedation, as an alternative to euthanasia.

Within 10 minutes of having her first dose of sedative, Col Pieper's terminally-ill mother drifts to sleep.

A medication pump is set up to continuously give her the sedative midazolam to ensure she stays asleep until she dies.

Three and a half days later, she dies peacefully, as she had chosen.

Pieper, a West Coast-based registered nurse, says her mother had originally wanted to be euthanised, but switched her thinking only weeks from death once she learned about palliative sedation.

She could choose because she lived in the Netherlands, one of a few countries in the world to legalise euthanasia.

The euthanasia debate has reignited in New Zealand with Labour MP Maryan Street's End of Life Choice private member's bill, which she lodged in the ballot box in July. It must be selected before it can be considered by Parliament.

Late last month, Prime Minister John Key faced strong criticism from the medical profession after claiming euthanasia was happening in our hospitals and that he would consider it if terminally ill.

Hospice New Zealand's clinical director, Associate Professor Sandy Macleod, says Key was incorrectly informed but agrees the public has little knowledge of other end-of-life options, such as palliative sedation.

"In euthanasia, you are trying to kill the person. In palliative sedation, you are trying to kill the intractable symptoms," Macleod says. "There are plenty of options other than killing people that we have at our disposal."

Palliative sedation is quite common practice in New Zealand hospices when someone is within days of death and suffering distressing, uncontrollable symptoms, such as delirium or extreme breathlessness, he says.

A Christchurch study found a quarter of people dying at the city's hospice had palliative sedation, he says.

In the Netherlands, medical guidelines state a terminally-ill person must be within two weeks of death and suffering unbearable symptoms that are unrelieved by treatment to qualify for palliative sedation.

While no such formal guidelines exist in New Zealand, it is discussed in the Palliative Care Handbook.

Pieper's mother, Annemie Verschuren, first developed bowel cancer 17 years earlier but surgery and chemotherapy cured her.

In April last year, she was again diagnosed with bowel cancer. It had already spread to her liver and lung, removing hopes of a cure.

Chemotherapy controlled her tumours for many months but by March, it was stopped because her cancer was growing fast.

In late March, Verschuren, 77, and Pieper's father, Ted, arrived in Hokitika for a 16-day visit.

"New Zealand was the last thing on her bucket list," says Pieper, 48.

Unfortunately, two days after arriving, her mother became very sick. "Our goal was to get her well enough so she could get on the plane to go back home at the end. And we did."

By the end of May, all treatment had been stopped and Pieper went to the Netherlands, knowing her mother was dying.

Her parents had decided several years earlier to opt for euthanasia if they became terminally ill but about two weeks before Verschuren died, she changed her mind.

Pieper suspects it ultimately clashed with her religious beliefs.

However, her GP told her she could opt for palliative sedation but only if she had unbearable symptoms that were unable to be relieved and had only 14 days left to live.

"She said ‘Oh yeah, that's what I want'."

She and her six siblings supported their mother's choice.

"Everybody in the end was really happy with it but some struggled. For me as a nurse, I don't struggle with it at all."

Five days before Verschuren died, she told Pieper she had had enough.

"I told her she needed to talk to Dad. They'd been married 56 years."

Later that day, Verschuren asked her GP if she could start taking the sedative but he refused because she was yet to develop intractable symptoms, such as her bowels blocking.

However, Verschuren knew she had little time so all her family were called to visit the following day for her final day awake.

It was an emotional experience but the family was united in supporting their mother's choice to be sedated until she died, Pieper says.

The next day, the GP returned and tests showed her bowels were blocked.

"Mum told him she had had enough and wanted to go to sleep. He asked her when she wanted to do that, saying he had the drug in his car."

"What about now?" Annemie asked.

Pieper's dad, Ted, agreed it was time.

Before the doctor gave her the sedative midazolam via subcutaneous injection, he thanked her for her wonderful contribution to their community.

"Everything was so respectful towards life. That was great."

She has personal and professional experience of euthanasia as well as palliative sedation, including from her 16 years nursing in the Netherlands.

While Pieper supports euthanasia, she says palliative sedation is very different and a less dramatic option for people to chose.

During her time in New Zealand, she has never heard of palliative sedation mentioned and believes GPs need to be proactive in offering it as an option to dying people as is the practice in her home country.

"I can imagine it would give people comfort. It gave my mum comfort."

PALLIATIVE SEDATION

Intentionally lowering a patient's consciousness or putting them to sleep in the last phase of his or her life using sedatives. It aims to relieve a terminally-ill person's suffering caused by refractory or untreatable symptoms. Includes continuous sedation of someone until death or as a short-term reliever of symptoms. It does not hasten death and is reversible. Is allowed in New Zealand for people close to death.

The Press