Palliative care

Palliative care is the care given to a terminally ill person facing the final stages of his or her life. It is for people who have any medical condition for which there is no current cure and so whose health is expected to deteriorate progressively. It does not seek to lengthen or shorten their last days but to make them as rewarding and pain-free as possible. The emphasis is on comfort rather than cure. The patient has a say in all decisions about treatment.

This care is provided in the home, hospices and palliative care units attached to hospitals and is tailored to enable the person to be treated in the place he or she would prefer for as long as possible.

It is a service delivered by a team of health care professionals including doctors, nurses, pastoral workers, physiotherapists, chaplains and volunteers who have been trained in the best standards of care for the dying persons and their families.

The chief aims of such care are: the expert relief of pain and other distressing symptoms, seeking and respecting the legitimate wishes of the patient, good communication about the illness, its treatments and their consequences, honesty, and support for the patient and family to enable them to cope with anxiety and other emotional disturbances.

Palliative care demonstrates a profound respect for the emotional, physical, social and spiritual needs of the dying patient and the family. Maintaining true dignity in dying is made possible by caregivers and family comforting and caring for people even as their bodies and capabilities decline.

Often the last few hours or days of life are the most valuable to patient and family as old hurts are healed, old wrongs forgiven, unspoken love expressed. The dying person has time to reflect on his or her life and time for spiritual consideration. Friendships that have fallen by the wayside over the years can be renewed, memories relived.

Families have a chance to grieve and come to accepting the parting with their loved one, lessening the shock of the final loss. Offering euthanasia as a shortcut to dying could steal these most precious and deep moments of life.

Palliative care is a positive initiative that enriches the person, those around them and society in general.

How can you prepare for a comfortable death for you and the people you love?

Talk to your loved ones and doctor about these issues. It is better to know how they feel about it now than later. If you cannot accept your doctor’s approach you should change doctors. Find out which hospitals close to you have palliative care units or hospices.

A member of the Australian Federal Senate Committee made the following comment:

“Suffering patients cannot make real choices about their medical treatment unless good quality palliative care services are available throughout Australia. Regardless of whether active voluntary euthanasia is legalised, both Federal and State governments have a clear obligation to ensure more resources are devoted to research, training and service provision in the palliative care area.” (Page 173)

In his statement, Professor Peter Baume said “….but palliative care, even the best palliative care, leaves about 5% of people unrelieved. The figure may be a bit more or a bit less than 5%, but that 5% still remains a problem which we must address. For the other 95% of people, palliative care is very effective and it is developing. That 5% figure might shrink, but it exists at the present time….”

Palliative care experts indicate that no studies have been undertaken to show that there is a ‘percentage’ who cannot be assisted totally by palliative care. It was noted by a representative of AAHPC “There is an implication very often in this discussion that x%, 2,3,5 or whatever, has not relief of any sort.. that palliative care is either pass or fail; you either get total relief or you get no relief at all.” It was explained that ‘the group of people who do not get complete relief of their symptoms in fact do receive a proportionate degree of relief.’

Members of the Committee sought clarification of how palliative care can assist that small percentage of patients whose suffering is acute.

It was commented by a representative of the Aust & NZ Society of Palliative Medicine: “I think we have to focus on a small proportion and realise that, although we may not get the pain for the people in that group under total control, my experience is that we get it under such good control that they can live with it.

There are many other problems that come up at that time. Let us suppose we have the hypothetical patient who really does have such severe pain. I think we have to talk to them about whether they want to go on with this or whether they would like some more sedation. We have to talk to them about those sorts of things, and usually the patient will tell you what it is that they want.”

When asked what he would do for those patients who indicated that they have just ‘had enough’ the professor replied: “I have not had that experience, but if they did I would be talking to them about their mental state. I would be talking to them about family issues. I would be exploring the reasons why they had come to that conclusion, because often there are reasons that need to be sorted out … Often people who are in that circumstance have it explored by a sympathetic team and that may actually be a doctor or it might be an art therapist because a person just cannot tell you how bad it is, they need to paint it for you – or a music therapist.”

Another representative responded that: “Palliative care is more than just morphine .. Morphine plays a smaller and smaller part in palliative care science. There are other medications, other drugs; there are other ways of dealing with pain in particular. Pain is not the biggest issue in the dying. I think it is more a spiritual, a grief, an emotional thing. Often when people have pain which is out of control it is compounded by their other suffering, which can be addressed in other ways.” (Page 173)