The end of life surprise

31 Jul 2009

By Robert Hiini

More education for medical students and doctors will advance Palliative Care by light years, says Perth specialist.

 

 

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Demonstrators against physician-assisted suicide, some in wheelchairs, protest outside the US Supreme Court building in Washington in 2005. But relatively simple measures in the field of Palliative Care make euthanasia unecessary, a specialist in the field has told The Record. Photo: CNS/Reuters.

 

By Anthony Barich

 

 

Dr Derek Eng.

Euthanasia gains ground because of the medical education system’s failure and people’s desire to cling to a sense of control over their life and death so prevalent in western society, WA Palliative Care specialist Dr Derek Eng said.
Dr Eng, a Palliative Care specialist at St John of God, Royal Perth and Hollywood Hospitals, told The Record that the current push for euthanasia in WA following the passing of the Consent to Medical Treatment Amendments Act 2008 is due to ignorance among both the medical profession and the wider community about Palliative Care best practices.
It is an ignorance, he said, that is global because Palliative Care is a relatively new medical specialty pioneered in the United Kingdom.
There, St Christopher’s Hospice, founded in 1967, became the first hospice to link expert pain and symptom control, compassionate care, education and clinical research.
Many doctors, he said, have the misconception that Palliative Care is comforting people with drugs in their last days until death, a perception which flows on to the public.
But Palliative Care, he said, is the multitude of ways a patient’s physical and emotional suffering can be treated so that they can have a better quality of life.
“It’s unfortunate that a lot of doctors  still think that Palliative Care is just pain management near the time of death, so they don’t send anyone to us until people are about to die,” he said.
 “Palliative Care can make the biggest difference early on in the course of one’s illness.” A spokesperson for the University of WA’s medicine faculty said it has always taught Palliative Care in an ‘ad-hoc’ way, but it was only formally introduced into the syllabus in 2001.
Furthermore, there is a traditional fear of prescribing drugs like morphine for cancer pain as patients can become addicts, which is a myth, Dr Eng said.
The solution, he said, is more education for both medical students and doctors in the field, as Palliative Care aims to help bring patients beyond a sense of hopelessness and “normalise” patients’ lives as much as possible, preferably enabling them to return home rather than stay in a hospice or hospital.
The lack of awareness of Palliative Care means patients’ intractable symptoms often end up poorly managed. He said it is understandable for patients who endure prolonged physical and emotional suffering to wish for death as it is the only way out.
For cases like quadriplegia, recently highlighted by Christian Rossiter pleading with MPs in The West Australian to legalise euthanasia last month, Dr Eng said promoting a sense of meaning and hope into patients’ lives is the key – focusing on what they can do rather than what they can no longer do.
However, he accepts that patients have every right to say ‘that’s easy for you to say’.
While many of us define meaning in life by our careers, our responsibilities and duties such as bringing up children and looking after our families, a major setback like a cancer diagnosis or paraplegia will change one’s life completely and utterly.
When we lose our “meaning of life”, we lose our sense of self and feel worthless, hopeless and a burden. This happens to so many people who become critically unwell or severely disabled. He said that as providers of Palliative Care, they try to support and nurture patients through their traumatic life changing experiences and hopefully through all that they will find something that brings meaning to their lives.
“There will be a percentage of people who will never find meaning as their life is so vastly different than what they used to have, and when their life is devoid of all hope and meaning, then all they wish for is death, and there’s nothing we can do about that.”
He said that doctors like Dr Philip Nitschke who advocate right-to-die initiatives should not be demonised, as all doctors ultimately want to help their patients.
“What do you do when you’ve got a patient crying … begging you to do something? That’s where the moral line needs to be very clear, if it’s not then you’re in dangerous territory,” he said.
Euthanasia goes against the Hippocratic Oath sworn by all doctors, “above all, do no harm”.
“It all comes down to ethics. Yes, (the patients) want death, but do we have a right to offer and give it to them? The answer to that should be “no”. Patients then take that right into their own hands, they read books or the internet, and they think that because no-one can help them, ‘I’ll just do it myself’.
Faith may even have a role to play. “We have a fabricated sense of control that we think we can live life with some kind of predictability. If we can’t predict, we must put our faith in something greater than ourselves,” he said.