Current palliative care treatments are already compassionate. Introducing VAD will only undermine patients trust in medical professionals.
The Church is not the only voice in the Voluntary Assisted Dying debate. There are many secular groups that echo our position calling on the State Government to provide real choice by providing ‘palliative care first’ – including Palliative Care Queensland, the Nurses Professional Association of Queensland, as well as the many medical experts and healthcare institutions like the Mater and St Vincent’s Healthcare Australia. Dying with dignity already exists – it lies in being able to access high quality palliative care state-wide.
Here is a real chance to learn from one of those at the coalface. These are the views of a Doctor with the Queensland Care Alliance. Dr Luke is appealing to Queenslanders to take urgent action to contact their local MP to support palliative care not euthanasia:
Here is the transcript of the video:
Who am I
My name is Luke Garske and I am organising a grassroots campaign opposing voluntary assisted dying (VAD). I am a chest physician with experience caring for patients with a range of severe lung diseases. I have had the privilege of caring for many patients through a journey which starts with diagnosis of their condition, leads to treatments with uncertain outcome, and sometimes ends in their death. I have often given palliative care myself, and I have worked closely with a range of palliative care services. I was present at my father Ray’s death. My daughter has an intellectual disability and I hope my daughter will outlive me. So I am interested in compassionate dying, but there is nothing special about my interest. Every Queenslander knows we will eventually die, and most of us will have a loved one who dies.
What is happening
The Queensland Parliament will be debating a bill to introduce voluntary assisted dying (VAD) for about a month starting from the end of August. It is believed that this bill is likely to pass. VAD looks like this:
- a patient expected to live less than 12 months can be offered VAD
- that patient needs to have any doctor of 5 years experience agree that they have sufficiently limited life expectancy, that they are capable of making that decision as they have no mild depression or confusion, and that no one is co-ercing them for ulterior motives. It sounds impressive to have 5 years experience doesn’t it, but I’ll tell you what that actually means. This would typically be a registrar in the hospital, somebody who is partway through their training in whatever field they have chosen, and requires supervision by a consultant (so basically they are an apprentice). When I was at that stage, I didn’t know what I didn’t know, and I was overconfident at times. The Doctor need not have any training or experience with the particular condition, making it likely they will make large errors in estimating survival. Would you ask an apprentice electrician to fix your plumbing?
- after a short cooling off period, a patient is provided with a box which contains medications. They would be expected to die within hours after taking this
- there may be options for doctors or nurses to administer medications by injection to promote death within a shorter time
- The legislation in Queensland has some notable exceptions compared to other states
- Queensland doctors will be allowed to initiate a discussion about VAD, rather than the patient initiating the discussion as in Victoria. Although some patients take control of their health decisions, there are many who trust their Doctor to make most decisions.
All doctors make mistakes. They make mistakes in assessing how long someone may live. I have had patients recently who I was sure had only weeks to live, but I recently had a smiling conversation with them 8 months later in the hospital corridor. It’s easier to tell someone is in the last days or weeks of life, but there will always be major uncertainty in saying someone is in the last 12 months. I have no idea how to assess whether someone is being co-erced by a member of their family to have VAD for ulterior motives. Doctors are bound to miss coercion too.
Why you should support good palliative care not VAD
VAD has been promoted by the media and some politicians as the compassionate option. In places where VAD has been done for a while, the reality is that people choose VAD to have control over the circumstances of their death, or because of they are lonely. Most people do not choose VAD because of intolerable suffering. However, I get this strong desire for control. People often raise VAD with me at the time of their initial diagnosis, and they usually say that is because they are afraid of future distress, or of being a burden on their family. When I reassure and care for these patients, these fears and concerns always settle.
Current medical practices to relieve symptoms are compassionate. When patients have excessive suffering they can choose to withhold or cease treatments which prolong life, even basic treatments such as antibiotics. If patients have severe distress caused by their disease, they can have progressively increasing doses of morphine and sedating indications to take all the worst of the distress away. We are never going to run out of morphine, and we can increase doses as needed to the point of being effectively anesthetised. We know this can shorten their life but this is done because it’s clear that the patient wants relief of distress more than a longer life. All these measures are already happening, are centred on the patient’s goals, and are entirely legal.
Medications and pain relief are only one element of palliative care. Good palliative care teams address the whole person including their physical distress, emotional distress and their sense of connectedness. If someone feels anxious, lonely or insignificant, their pain or breathlessness will be more severe. Adequately resourced wholistic palliative care is very effective at dealing with these other elements which increase physical distress. Palliative care is not adequately funded in Queensland and there are some areas with virtually no service. There are estimates that up to 2 in 100 patients have moderate or severe distress in the last weeks of their life, but I would bet my house that most of those patients did not get access to high quality palliative care early enough. Every person with a life limiting illness deserve a better death supported by good palliative care. I believe the Queensland premier has stated she does not think it will be financially possible to introduce adequate specialised palliative care for many rural and remote locations. I don’t understand why, as it’s not expensive when compared to so many other things we do. If VAD is introduced, patients in many parts of Queensland will choose not to have VAD because that’s the optimistic common human response to terrible diseases that I see every day. It should be their right to choose to live with good palliative care. They will continue to be faced with suffering caused by inadequate palliative care. If complaints are made, VAD will be the cheaper answer. The extra palliative care funding measures currently planned are welcome but are only a small fraction of what is required. Everyone has a human right to good quality palliative care and that right should not depend on your postcode.
If VAD is introduced, patients will no longer be able to trust that their doctor, nurse and pharmacists are only focused on trying to give them the best life possible; it will erode trust because of all the social and economic forces that may lead health care professionals or family members to decide that someone’s life may no longer be worth living.
What you can do
Please consider contacting your local member and arrange an appointment to express strong opposition to the bill. Please persist with this. If you just email a letter or phone you may get no response, so please find a way to request an appointment in person if needed.
If your local member is not open to discussing changing their vote, you can suggest that amendments may be essential for your continued support, to at least limit the damage. At the very least, the bill should be amended so that good palliative care is a human right available to all Queenslanders with limited expected survival, irrespective of their postcode. And you should have the right to a specialist with training in palliative care to assess and help patients who are requesting VAD
Please forward this message to anyone, especially those more likely to be most affected: disability care organisations, aboriginal and torres state islanders, minority groups, nursing homes, any religious group/church, health professionals.
You can also consider joining the grass roots campaign which I am organising with a group of health professionals including Nurses, Doctors and Pharmacists.
Please talk to your family and friends, and talk to anyone you meet.
Thank you for your time, and please make sure you act.
Dr Luke Garske
Queensland Care Alliance