Palliative Care

Palliative Care involves not only looking after a patient's medical requirements, but also caring for the spiritual and emotional needs of the patient and their loved ones.

  • "The emphasis is not on what you have lost, but on what you do with what you have left."
  • Inadequate care for patients suffering from cancer and other incurable diseases, is a major national and international health problem.
  • The Netherlands is one country where palliative care was relatively unknown prior to 2001.
  • Once pain and other symptoms are under control, people are enabled to deal with their unfinished business.
  • Over the next decade the term, palliative care, will likely be 'hijacked' by the euthanasia lobby.
Unendurable pain, loss of body functions and dementia, are terrifying prospects facing people entering the latter stages of terminal illness. Understandably, assisted suicide or euthanasia can appear a desirable option. An opportunity to escape the suffering and physical deterioration lying ahead.

The alternative medical treatment is called "palliative care", or "care for the dying". There are 37 hospices providing palliative care services around New Zealand.

What palliative care means
Palliative ? means a shield, a big shield that covers the front of the body. Palliative care is about protecting the patient from their illness. As one hospice doctor said: "The emphasis is not on what you have lost, but on what you do with what you have left."

The pioneers of palliative care are Dame Cicely Saunders and Elizabeth Kubler-Ross. They instituted the modern hospice movement in 1967 and inspired many medical schools to improve care-for-the-dying training in their curriculum.

The World Health Organisation (WHO) in 1990 recognised that inadequate care for patients suffering from cancer and other incurable diseases, was a major national and international health problem. The international panel recommended more palliative care programmes and defined palliative care as: "the active total care of patients whose disease is not responsive to curative therapies."

Such care entailed: effective control of pain, relief of mental distress and focussing on the patient's quality of life. The term "palliative" could include hospices, hospital or home-based, patient and family-centred care.

The panel recommended that member states not consider legalising assisted suicide or euthanasia, until they had assured for their citizens, accessible services for pain relief and palliative care.

Palliative Care in The Netherlands
The Netherlands is one country where palliative care was relatively unknown. Medical students graduated with little knowledge of pain relief and care for the terminally ill. This was a major factor in the public and medical acceptance of euthanasia as a medical treatment.

One report gave the number of hospices in the Netherlands in 2001 as just two.

Dutch patients with terminal cancer faced a fearful dilemma. They could choose to endure the pain (with the doctor doing his best within the bounds of his training), or request euthanasia when the pain became unendurable.

For many doctors, aware of their inadequacies to treat pain, or provide relief from other ailments, euthanasia provides a simple solution.

There is now a growing awareness that proper training in palliative care is essential ? and that more facilities and hospices are required. The few existing hospices provide training programmes to complement what is being established in the medical schools.

How Palliative Care is applied
Dame Cicely Saunders set the goals for the hospice movement:
  • To care in a humane manner for the terminally ill
  • provide not merely for the patient's medical requirements, but also for the spiritual and emotional needs of the patient and loved ones
  • To give to family and friends an opportunity to share actively in the care, comfort and support of the dying individual

  • To make the patient's final days as painless, happy and meaningful as possible
Dr John Bolifant, then a GP and Medical Officer at Wellington's Mary Potter Hospice, provided these insights at a conference in 1992:
"The dying person asks: 'Help me? Listen to me? Stay with me? Remember me'

"The needs of dying people relate to the physical, emotional, spiritual and intellectual parts of the person. He praised GPs and nurses who work hard to acquire the skills of managing chronic pain, through the training courses run by the hospice.

They receive a high rate of referrals to treat respiratory problems "which are very scary to the carers as well as the patients."


Chronic pain

"First we have to take a careful history to determine the nature of the pain which the patient presents. Then we apply a series of tests and diagnosis to get the best results. There is a hospice saying about treating chronic pain: ?The right drug, by the right route, by the clock.'

In New Zealand we use morphine. It is freely and widely available and there is a wide range of doses. It has a very high level of safety, you don't kill patients with morphine.

We have found that giving morphine in appropriate doses for pain relief to patients with marked airways disease has often improved respiratory problems.

Everybody on opiates is constipated. Everybody - without fail. You must use a stimulant laxative when prescribing opiates."

Difficult cases

"About 80-85% of patients that have their pain treated in hospice, have it treated to their, and their carers' satisfaction. That's the very good bit. There's another 10% group where the carers and the professionals don't think that the pain control is satisfactory, but the patients say they're happy with that.

But there's no doubt there's a small group of patients where you desperately try every trick you can and in the end you are left with trying to make them as comfortable as possible.

Some of them and some of the families will agree that they should be allowed to sleep and we would use flunitrazepam infusions to try and induce that when everything else seems to have failed, to allow them to have a degree of comfort and dignity and relaxation.

That doesn't mean we are ?ironing' them out. That is not what I am talking about. We try to achieve a degree of comfort from grave distress, but we all have tough patients when we don't succeed ? when the agony to the carer is almost as great as it is to the sufferer. And then we have deaths which we think and feel are bad deaths and where we grieve even more as carers.

So there are tough ones and some of them really get to you. We don't win them all. I don't want to paint a false picture, but in 98% of patients we do help.

Unfinished business

"Once pain and other symptoms are under control, people are enabled to deal with their unfinished business (emotional, social and spiritual). Patients if they choose to do so, then have a chance to sort out relationships, or deal with spiritual matters appropriate to them. We cannot make it happen, but we open doors which patients may choose to go through.

We help people to get on with living ? hospices are not ?death houses'. Two thirds of our patients are discharged home. Hospices may be nice places to die in, but we need to offer people choices.

Hopefully we can help people to understand that death is not a medical failure, but that death is healthy and its OK to die at home. Hospice is not about a rapturous end for all, but allowing people to live and die in character."

Prediction

"Over the next decade I predict the term, palliative care, will be 'hijacked' by the euthanasia lobby. The deception is spreading that a person can have "death with dignity" only by choosing death through active or passive euthanasia.

Unless we issue a strong challenge, palliative care may soon become a euphemism or synonym for choosing death, thus making a mockery of its origin as the active alternative to euthanasia." [Dr. John F. Scott, HUMANE MEDICINE VOL.8 #4.116. APR.1992] Jean Echlin, RN, MScN (Nurse Consultant---Palliative Care) in her opposition to Canada's C-407 euthanasia Bill, says:
"If euthanasia and assisted suicide were legalized, this would adversely affect the priority and need placed on the development of palliative care standards and norms of practice already developed by the Canadian Hospice Palliative Care Association (CHPCA). Expert palliative care requires a commitment of health care dollars.

Euthanasia and assisted suicide is a financial, moral and ethical "cop out!" With financial efficiency and expedience a health care priority, these killing methods may catch on quickly in a system strapped for money and resources. Doctors and nurses should not be killers.

Euthanasia treats people as disposable objects. All Canadians should be concerned...even frightened by the possibilities. " Why Should Canadians Oppose Bill C-407?