Good palliative care could avoid need for euthanasia debate - expert

South Canterbury District Health Board palliative care medical lead Michael Downing.
John Bisset/FAIRFAX NZ

South Canterbury District Health Board palliative care medical lead Michael Downing.

If palliative care was consistently of high quality, and fully available, New Zealand would likely not need a debate on assisted suicide, an expert believes.

ACT leader David Seymour's End of Life Choice Bill is currently before Parliament's health select committee, following a period of submissions which closed on February 1.

Dr Michael Downing said for a small percentage of the population it was extremely important to appoint their own time of death, but he asked if that was a good reason to change the law.

"To what extent do you modify the law for a very small but important percentage?"

The Canadian-born doctor has been the palliative care medical lead for the South Canterbury District Health Board for two years.

He saw the legalisation of physician-assisted suicide in Oregon in 1999, and in his homeland of Canada in February 2015. He said he was now hearing the debate in New Zealand.

A broad sector of the population supported legislation for assisted suicide here, with 71 per cent wanting a law change in a 2015 New/Reid research poll.

Based on other countries' experience, however, only a few would follow through with it if legalised.

"It's an interesting mismatch."

If palliative care was consistently high quality, accessible and saw more money spent on research for end of life drugs and services, New Zealand would likely not need to have the assisted suicide debate, he believed.

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Pro-euthanasia and pro-life groups came from a similar ethical base, wanting dignity, comfort and support at the end of life but by very different means.

"All kinds of patients die now with dignity, peacefully and with grace but yes, many also die in pain, alone and sufferring."

Data collected in Oregon showed fear of pain was not in the top 20 reasons people wanted to die, he said.

The top three reasons were:

1. Autonomy - my right, my body, my death.

2. Loss of enjoyment of life.

3. Loss of dignity.

Of the 30,000 deaths in Oregon last year, of which 93 per cent were registered with hospice,  0.3 per cent went through the process of obtaining a lethal prescription.

"There were 155 people who obtained the lethal prescription, 105 took it (and died), 50 went on to die without taking it."

Downing said some of the latter just wanted to know they had the prescription if things got too bad.

"I would like to think with good hospice care they were able to leave it in their back pocket."

Not all hospice care was the same high quality, he said. Education to build competent clinicians and more research on drugs for the pain at end of life were two aspects he believed offered solutions.

FOCUS ON LIVING LIFE TO THE FULL

When people think of hospice they often think of death but that is only one aspect of its purpose, Hospice South Canterbury staff say.  

The preciousness of living every moment and neither hastening nor prolonging life was Hospice New Zealand's mantra.

General manager Peter O'Neill said the organisation respected the fact that there were other views on end of life scenarios.

"And this is ours . . . we see death as a natural part of life." 

The focus was on life and living it to the full, as comfortably as possible, he said. 

Because in Western culture death was often not discussed, or was feared, nurses and counsellors could walk with "the key person" and their family members on their journey, he said.

They could  guide family members on asking the patient valuable questions about their life or opinions which may otherwise not be asked.

O'Neill said he thought many people did not understand or know about hospice's holistic services and if they did they would not want physician-assisted suicide introduced. 

The supportive hospice environment offered symptom management and respite care, as well as a place for a patient to spend their final days, if that was what they wanted. 

"We are patient-centred. There is a lot of laughter with family and friends sitting around reminiscing. It's precious to see that."

Family support counsellor Viv Macfarlane said some patients came and went six or eight times over a year, so hospice became a familiar place to them. Ultimately it was their decision where they wanted to be when they died and that choice was always honoured.

"Half the patients who die will die here, the other half will die at home or in care."

Unlike a hospital, hospice catered to a person's spiritual, physical and emotional wellbeing, and their family, she said. 

"They know they are here to be cared for."

In the time at hospice there was the opportunity for family members to reconcile and for good memories to be formed.

Physical pain could usually be controlled but sometimes psychological pain relief was a little harder to administer, Macfarlane said.

"It can be fraught if a soul was not settled. It depends on their belief system."

More often than not a patient came to terms with their impending passing and died peacefully, she said.   

Death with dignity was affirmed by hospice, as living well until taking a final breath, naturally, O'Neill said.

"There is no need for assisted suicide."

FACTBOX

Hospice South Canterbury provides free-of-charge palliative and respite care to all residents in the region.

It caters for more than 150 patients and their families in its seven-bed unit each year.

The annual budget of $1.55 million is met by a district health board contract of $900,000 and $650,000 raised through fundraising, grants and bequests.

Hospice is opposed to proposed physician-assisted suicide legislation. 

 - Stuff

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