Senior physician answers the question on euthanasia advocates’ lips
By Anthony Barich
MOTOR Neuron Disease (MND), otherwise known as Lou Gehrig’s disease in the USA, is often more frightening than cancer for those who have it and their loved ones, St John of God Hospital Subiaco Clinical Dean Dr David Watson said. Yet the severity of such diseases were the very reason palliative care was developed in the first place – to develop better research into treating them, Dr Watson said.
MND, a progressive neurological disease, affects approximately 1400 people in Australia and thousands more – their carers, families and friends – live daily with its impact. On average every day in Australia at least one person dies from MND and another is diagnosed.
It is such frightening scenarios that come up when the euthanasia debate heats up, along with terminal malignancy. “There’s no doubt that motor neuron disease, among those who have experienced it, is far more frightening than cancer, and for those of us who have friends or family with it, it’s a real challenge,” said Dr Watson, Professor of Medicine at the University of Notre Dame Australia in Fremantle. “This is one of the reasons palliative care came into place in the first place – the need to develop better research into these diseases.”
Medically and pastorally, MDN presents a very special challenge, Dr Watson said, and “none of us would feel confident we’ve got all the answers”. It depends very much, he said, on how to treat the individual. MND also raises issues about tube feeding (do we always offer it, when do we withdraw it)? which the law has had to deal with.
Planning and providing palliative care for these and the whole raft of cases that palliative care deals with is a complex business, not to mention expensive.
When Dame Cicely Saunders – the prominent Anglican nurse, physician and writer famed for her role in the birth of the hospice movement, emphasising the importance of palliative care in modern medicine – visited Perth 30 years ago, she said hospices should be remote from major hospitals. The Cottage Hospice in Shenton Park that the previous WA Labor Government closed down was started under such a premise.
But palliative care has advanced so much since then that a dedicated hospice should still be a distinct facility but should be close to a full acute hospital. Such a free-standing hospice has been set up just across the carpark from St John of God’s tertiary hospital in Murdoch which provides a full range of medical and surgical services.
“That has advantages as there are all the physicians you need on tap,” said Rev Dr Joseph Parkinson, LJ Goody Bioethics Centre director who is also on the SJOG and Mercy Care ethics committees.
At the same time, staff are able to develop the specific skill set to do palliative care well.
But there can always be improvements. While there are 10 palliative care beds at SJOG Bunbury and 20 at Murdoch, there can arguably be more if the State government is able and willing to fund it.
“There are lots of issues that need to be thought through carefully, so we’re saying to the (State) government that if you can put some of money up we’re prepared to do the work,” he said.
“It is a State responsibility to ensure the State has an adequate number of palliative care beds and an adequate level of palliative care.”