A senior palliative care physician has warned that terminally ill people will fear entering palliative care due to voluntary death assistance laws nationwide.
Maria Cigolini, clinical director of palliative medicine at the Royal Prince Alfred Hospital in Sydney, said many people are already shying away from palliative care for fear that such units facilitate euthanasia.
“This will amplify that misinformation and fear of authority, especially among migrant groups and the homeless,” she said.
“Potentially, Aboriginal people will avoid health care, as we saw in the Northern Territory in the short time VAD was offered there.”
She mentioned the case of a man she knew whose elderly parents in the Netherlands avoided going to the doctor for general health care because euthanasia is so widespread there.
If VAD is considered a “choice situation,” she says it should be managed outside residential aged care rather than imposed on those situations. A requirement that VAD is offered in palliative care departments could lead to top-down decisions that do not allow physicians a say.
“In some hospitals in Victoria, there is no protection for that, even if you can conscientiously object. It can create a situation where someone is killed in a palliative care unit. Most staff are expected to deal with that situation and prepare everyone as if nothing happened,” Cigolini said.
“The moral distress that will ensue, and the idea that people might worry that they’ll be next; the safety of the care environment can be compromised and cause fear and distress for nurses, doctors, patients, and residents themselves.”
She says palliative care units in Canada have closed, and many people have left palliative care because of such issues.
The World Health Organization has stated that palliative care is a human right that should be provided to anyone with a life-limiting illness. Still, the recently passed NSW VAD legislation does not require referring a patient to palliative care “or even seeing a specialist.” who can ensure that their disease is treated optimally.”
Colin sees a degree of hypocrisy that NSW legislation was passed without a requirement for adequate funding for palliative care, particularly in the regions, and without considering the recommendations of the Royal Commission on Aged Care or waiting for the findings of the Royal Commission on Violence, Abuse, Neglect and Exploitation of People with Disabilities.
“So in terms of the impact, it’s serious because even though it’s touted as a choice, for a lot of people, it means there’s no choice — they have VAD but not the high standard of care alternative,” she says. Say.
“And in terms of funding, federal and state governments are falling far short of developing adequate palliative care across all sectors, especially regional and aged care.”
Colin says her clinical experience, supported by research, shows that when a person has a positive therapeutic relationship with their doctor, they don’t feel the need to act on their desire to die near the end of their life “because they feel supported.” and feeling guided and sufficiently helped in those final years, months or weeks or even days.
“Clinical experience based on the work of [Canadian psychiatrist] Harvey Chochinov found that the desire to die fluctuated a lot and was very dependent on the circumstances and who was in the person’s life,” she says.
Even participating in a study reduced the desire to die without any other intervention “possibly just because the person felt their life was being validated.”
While patient factors, such as a lack of family cohesion and feeling like a burden, fueled a patient’s death wish, clinical factors were also key drivers, according to research by medical researcher Brian Kelly, Pro Vice-Chancellor (Research & Innovation) Office – DVC (Research and Innovation) (Public Health), University of Newcastle.
“Physicians who have a pessimistic view of the patients and who were not palliatively trained were more likely to persist in their desire to die than those who saw a different kind of hope and were palliatively trained,” she said.
“The actual legislative practices expected of clinicians and physicians are inconsistent with the standards of clinical practice and how to approach someone in this situation.”
Colin said the fact that a doctor could suggest VAD to a patient in NSW undermined a positive therapeutic relationship.
“Since it’s a therapeutic relationship, the power of suggestion is so great and so devoid of the usual rigor of history taking and referral,” she says.
“Standards for patient safety are also ignored in this bill. It is also inadequate around the issue of competence and mental health issues, and there is no way to check for coercive influences. We know that elder abuse is a big problem, and financial abuse is even bigger. So all these things result from bad legislation and will mean making mistakes and people missing out on what we should owe our elderly and vulnerable citizens.
“The preamble to the bill states that there should be no undue influence, but how the process is framed creates undue influence. They are not required to provide palliative care or other in-bill care, so they can likely promote a sense of hopelessness and depression without being diagnosed. So it’s a shame.”
