Raised awareness of assisted suicide and voluntary euthanasia and the Church’s contrasting teachings brings our attention to palliative care, allowing people to die with dignity and free of pain. Dr Sinéad Donnelly, a palliative-medicine specialist, who says euthanasia ‘puts the soul of medicine on trial’, explains palliative care practice in this country.
Dr Sinéad Donnelly
Palliative derives from the word ‘pallium’, a ‘cloak or shield’. We who provide palliative care are shielding the person or cloaking them in care. We can’t cure or take away the underlying progressive illness but we can holistically support the person physically, emotionally, socially, spiritually.
The UN World Health Organisation defines palliative care as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness.
Palliative care affirms life, regarding dying as a normal process, and provides relief from pain and other distressing symptoms. It is applicable early in the course of illness, in conjunction with other therapies intended to prolong life. It offers a support system to help patients live as actively as possible until death. It includes those investigations needed to better understand and manage distressing clinical complications. A team approach addresses the needs of patients and their families to enhance quality of life, and perhaps positively influencing the course of illness. It offers support to help the family cope during the patient’s illness and in their bereavement.
In New Zealand palliative care is provided for people in their homes, in rest homes, in hospital and in hospices. At home and in rest homes palliative-care teams, affiliated with local hospices, support community nurses and GPs to care for the needs of people facing imminent death. The aim is for GPs and district nurses to be sufficiently knowledgeable and skilled to provide generalist palliative care, consulting specialist palliative-care teams when a patient’s needs patient are more complex.
Palliative care was originally associated with care of people who had advanced progressive illnesses such as cancer or motor-neuron disease. Now the aim is ‘palliative care for all, when they need it, where they need it’. For example, if a patient were dying from advanced heart failure or kidney failure causing them distressing symptoms, good medical and nursing care will entail a palliative-care approach. The GP may determine involvement of the community palliative-care team would help to provide the best care, so a referral is made to the local hospice team.
The word ‘hospice’ originally referred to the place where people were admitted for symptom control or the place in which people died. Nowadays, palliative care, palliative medicine and specialist palliative care replace traditional ‘hospice’ care and refer to an approach and standard of care rather than a specific location.
About a third of people die in hospital so this is where doctors and nurses skilled in palliative medicine can make a significant difference in the care of the dying patient and their whānau/family. Palliative-medicine specialist doctors train for three to four years in the community, in hospices and in hospitals learning, among other things, the science of pain control.
In the past 10 years great strides have been made internationally in palliative-medicine research and improving our ability to relieve symptoms. In New Zealand it is concerning there is a shortage of doctors specialising in palliative medicine. Failure to resolve this shortage may hinder the development of a sustainable palliative-care service in this country.
Internationally it is recognised ‘palliative care is everyone’s business’. Inspired by this slogan, compassionate communities are being organised in villages and towns where people gather to discuss how to care for neighbours who are dying or bereaved, and values around dying and death. An example is the Compassionate Communities Project, a pilot initiative of Milford Care Centre, a specialist palliative-care provider for mid-west Ireland.
This would be an exciting venture to get off the ground in New Zealand parishes.
Dr Sinéad Donnelly MD, FRCPI, FAChPM, is Consultant Internal Medicine, CCDHB, Wellington; Senior Clinical Lecturer and Module Convenor Palliative Medicine, Otago School of Medicine, Wellington; Adjunct Professor School Biological Sciences, Victoria University, Wellington.