SAVES is not affiliated with Exit International / Dr Philip Nitschke and opposes the public availability of a 'peaceful pill'.

In the debate on voluntary euthanasia it is common to hear the argument that ‘modern palliative care makes voluntary euthanasia unnecessary’, or ‘palliative care has all the answers’. In response to these assertions the question has been raised ‘what other specialty can claim a 100% success rate?’ ‘No discipline is perfect, and it follows that there will be some whom palliative care cannot help. Perhaps, for them, euthanasia does need to be an option.’ (1)

Readers of The VE Bulletin over the years, and individuals and educational bodies accessing SAVES’ Fact Sheets, will be well aware of a range of surveys on end of life decision making (2, 3, 4). However none of these surveys included research on the availability and/or efficacy of palliative care in the context of these decisions.

Quite recently the questionnaire used in earlier surveys in the Netherlands, and replicated in Australia and Belgium (Flanders) was utilised for a survey of 2602 New Zealand medical practitioners. This survey, returning 1255 usable responses, is different from the earlier ones in that it reported on the instances of physician assisted death in conjunction with access to palliative care services (5).

It was found that in 1116 (89%) of respondents’ cases there was access to an interdisciplinary palliative care team. Yet in 39 (5.6%) cases death occurred by ‘actions consistent with euthanasia or physician assisted suicide’. Another important finding was that in seventeen of these cases the patient was not consulted. This is a finding consistent with earlier research. In thirty four (87%) of these decisions palliative care services were available. The research also found that there were another 226 cases in which there was either partial or explicit intention to hasten death, even though palliative care services were available.This begs the question as to whether the decisions were made because optimal palliative care was unavailable, or whether even that level of care was unable to palliate the range of symptoms endured by those facing imminent death.

There are therefore inconsistencies between statements suggesting the universal efficacy of palliative care and the research findings, leading to concerns over how such claims can really be justified.

As has been argued on other occasions in The VE Bulletin, the 1999 Palliative Care Australia Position Statement on Euthanasia contains statements leading to a serious dilemma:

1.‘palliative care practice does not include deliberate ending of life, even if this is requested by the patient.'

2.'Acknowledges that while pain and other symptoms can be helped, complete relief is not always possible, even with optimal palliative care', and

3.'Recognises and respects the fact that some people rationally and consistently request deliberate ending of life.' (6)

The dilemma arises for patients who are unable to have their suffering relieved. Where does this leave them? Such concerns are reiterated in the findings of the New Zealand research that concluded that ‘New Zealand requires greater commitment to the provision of quality palliative care or a re-examination of the legal framework that surrounds decision making at the end of life, or both’.

In Tasmania a specialist physician in palliative care has left because the service was poorly funded and she was not paid as a specialist. The Palliative Care Service director, Dr Paul Dunne, said that specialists were not yet recognised by the Australian Health Commission and therefore paid accordingly. (7)

SAVES is always supportive of palliative care but recognises that it has limitations. The following letter has been sent to members of the House of the House of Assembly, providing them with information on the range of intractable symptoms that are difficult, or impossible, to manage with even the best palliative care:

To all members of the House of Assembly

Do you think that palliative care has all the answers, and the Consent to Medical Treatment and Palliative Care Act is all we need?

It is an irrefutable fact that even the best palliative care cannot alleviate all suffering.

Dear Member,

This fact is widely acknowledged, including by Palliative Care Australia. Despite optimal palliative care, between 5-10% of people continue to experience intolerable suffering and rationally request assistance to die. This figure represents thousands of Australians. Death is the only way in which a minority of suffering people can gain final relief and, without choice for voluntary euthanasia, the law effectively perpetuates their suffering.

For your information I enclose a paper entitled "A synopsis of disease and symptoms which are at best difficult, at worst impossible to control with modern palliative care" (available on SAVES’ website).

Without choice for voluntary euthanasia, our cruel law forces some people to either endure their intractable suffering to the bitter end or desperately seek to end their lives.

If their unbearable suffering forces them into the latter drastic action they are then forced to:

• act prematurely, while they are still physically able
• research their own death
• often resort to gruesome means of self deliverance
• face the very real and horrific prospect of failing
• do all this alone, while suffering most cruelly, without the comfort and support of loved ones.

Can you imagine yourself or your loved ones being one of those 5-10%? For the love of humanity, please support the Dignity in Dying Bill.

References:

(1) Kirk, E P, O’Regan S J (2003) ‘No discipline is perfect’, British Medical Journal, www.bmj.bmjjournals.com/cgi/eletters/327/7408/202#34846

(2) Van der Maas PJ, van Delden JJM, Pijnenborg L, (1992:22 special issue) ‘Euthanasia and other medical decisions concerning the end of life’, Health Policy http://image.thelancet.com/extras/03art3297web.pdf "Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995, and 2001"

(3) Kuhse H, Singer P, Baume P, Clark M, Rickard M, End-of-life decisions in Australian medical practice. Med Journal of Aust 1997; 166: 191-6.

(4) Luc Deliens, Freddy Mortier, Johan Bilsen, et al. End-of-life decisions in medical practice in Belgium, Flanders. The Lancet 2000; 356: 1806-11. Comment by Kuhse H on the latter article was published in the Belgium journal Ethiek & Maatschappij, le trimester 2001, Jahrgang 4, Nr. 1, April, pp. 98-106.

(5) Mitchell K and Owens G, (2003) ‘National Survey of medical decisions at end of life made by New Zealand general practitioners’, British Medical Journal 327: 202-203

(6) Palliative Care Australia Position Statement on Euthanasia, March 1999

(7) "Palliative Care Underfunded", Margaretta Pos, The Mercury, 23rd July 2004