Palliative care and assisted dying are not mutually exclusive
Professor Julian Savulescu (pictured, Visiting Professor in Biomedical Ethics and Law, Melbourne University, University of Oxford) provided a piece for The Conversation ‘Sex versus death: why marriage equality provokes more heated debate than assisted dying‘ 18 October 2017, which includes the following interesting observations:
“One major objection to the assisted dying bill is that we don’t need it because good palliative care is sufficient. Relief of suffering is very important, and more should be spent on end-of-life planning and palliative care. But this objection is complicated for several reasons. If palliative care is outstanding, people won’t request assistance in dying. So there is no need to ban it.
More importantly, while palliative care may be able to control pain and suffering, it cannot do everything. Together with colleagues at Barwon Health and Oxford University, we surveyed 382 people from the general population and 100 attendees at an advance care planning clinic, where people think about and express their values relating to end-of-life care (##)…People care not only about pain relief, but also about dignity and independence at the end of life. These are much more subjective and less amenable to control by palliative care. So while palliative care can address part of what people care about, it may not be able to address all their values.”
## See British Medical Journal Research Report ‘Patient values informing medical treatment: a pilot community and advance care planning survey‘ 8 August 2017
In July Andrew Denton said “The late Clive Deverall, founder of Palliative Care Western Australia, ….was deeply saddened that some were determined to make this a war between assisted dying and palliative care. He understood, as do the eminent palliative care physicians helping to write Victoria’s law, that assisted dying works alongside palliative care. It is one more option available to a patient and their doctors at the end of life.
This is borne out in Oregon, where assisted dying has been legal for 20 years, and where 90 per cent of patients assisted to die are also in hospice care. Support for excellent palliative care and voluntary assisted dying are not mutually exclusive.”
“It is excellent that palliative care services may be improved in the Hunter and made more readily available. However, I do question the sentence: “Whether in a hospice, a hospital or at home, palliative care can make dying with dignity a reality, and not just a hope….. While palliative care is excellent at controlling most symptoms, there are some for whom adequate control is impossible….To make dying with dignity a reality, excellent palliative care and the legal option to choose an assisted death are both required.”Click to support the NSW Voluntary Assisted Dying Bill.