October tweetchat: Euthanasia and palliative care


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I have seen few topics that can simultaneously enliven a dinner party conversation and create such moral divides as the debate about euthanasia and physician-assisted suicide. Conversation increases in volume and speed. Wine glasses are clutched tightly to chests. Slippery slopes, autonomy, choice, sanctities and human rights to life and death are bandied across the room. Other party-goers are drawn in, almost against their will.

While this dinner party conversation may eventually give way to renovations or school holiday plans, the public debate continues.

Perhaps it takes hold so readily because we all share such a deep stake in the issue. Whether committed to autonomous, communitarian, religious, ideological or professional positions, we are all part of a broader community, sharing a common experience of human life and death.

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Unspoken… a theatrical perspective on advance care planning

End-of-life care and decision making is not something many people feel comfortable discussing, and yet is a conversation that all of us would benefit from having.

In order to generate awareness of and discussion around Advance Care Planning, Health Issues Centre is presenting a theatrically inspired event in Melbourne titled Unspoken (What Will Become of Me?).

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#ANZSPM16 tweet chat: Medicinal cannabis and palliative care


In recent years scientific research into the effects of cannabinoids has been on the increase. Some would say that not-so-scientific research on the effects of cannabis has been underway for many hundreds of years, in many different countries and cultures.

Until recently I didn’t know that our own bodies produce endogenous cannabinoids, the various effects of which are still being studied. 

Two years ago, colleagues had informed me that at the Montreal Conference 2015 it was a ‘smokingly hot’ topic. The most widely studied cannabis-derived cannabinoids are Cannabidiol (CBD) and Tetrahydrocannabinol (THC.) You may have heard of some of the medications that have ‘come to market’ since then:  Continue reading

cost of caring Tweetchat

I thought our most recent tweet chat on the cost of caring featuring Dr Merryn Gott was one of our best!

Thanks to James for moderating.

If you were unlucky enough to miss it, I have written a Storify which would provide a quick summary.


Have a lovely weekend, Sonia

I think therefore I am/Palace of Care – Hospice New Zealand 2016 Conference Keynote Presentation

Hi everyone,

Here is a copy of my slides from the Keynote presentation that I made on 16/09/16 at the Hospice New Zealand 2016 Conference.

I was intentionally being provocative and I was purposefully trying to challenge the audience’s mindset with the material that I presented, as I believe that New Zealand Hospice/Palliative Care needs to be “shaken up,” if it is to remain relevant. Now it’s your turn, you have been warned…

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I am working on a version which will have clickable links, and also on a recorded live performance of the presentation. In the meantime the slides with comments have been loaded onto the Palliverse Instagram account.



Tonight’s #pallanz tweetchat will be at 7pm AEST, which becomes NZT 10pm due to Daylight Savings time.

Hello to my Kiwi brothers and sisters.

Tonight’s tweetchat will be at 10pm NZT, we forgot to factor in the recent daylight savings time change. Please accept our apologies.

James only noticed when he dialled in one hour early to a teleconference with the rest of the team – Talk about feeling like a Nigel No-mates!

Catch you later on if you are still awake.


James for Team Palliverse.

#ANZSPM16 tweet chat: the (hidden) cost of caring


A game changer at the recent Australian and New Zealand Society of Palliative medicine 2016 Conference (#ANZSPM16) was Dr Merryn Gott’s plenary presentation on the hidden costs of caring. Little is known about the financial impact of caring for people at the end of life.

She detailed some powerful anecdotes, including the story of two sisters whose mother lay dying in a hospital. The cost of parking was prohibitive and the daughters took it in turns to sit in the car watching out for the parking inspector. When their mother died, only one of the daughters was there; the other was in the car. Continue reading

Art therapy for the palliative care clinician


I had wanted to learn to paint for many years, and finally found the time to take some classes during my research fellowship year. It was really good fun and I loved it. Unfortunately, my fellowship year soon finished and clinical commitments meant I could no longer attend the classes.


Nevertheless, I decided that I would keep painting, once a week (usually on a Wednesday), just for me. At the end of a busy day, it’s often easier to just slump on the couch and watch some TV. I’ll be honest, sometimes the couch wins. However, I do manage to drag myself out of the house again most Wednesdays, get myself down to the studio for a couple of ours of what I fancifully call my ‘art therapy’ before bed. And when I do, I never regret it.


As you can see, I’m just a beginner and still have a lot to learn about painting. But I love losing myself in the work, just thinking about form and colour – anything other than patients and families and suffering and medicine, or audits or guidelines or research or presentations. I also love heading out and painting outdoors when I can get away.


If you also like painting, or any other form of art – please join us for #PallANZ tweet chat on the 29th, which will be on the topic of “palliative care and the arts”! You can find the details here.

#pallanz tweetchat 29/9: Palliative care and the arts **N.B. This chat will be at 10pm NZT due to daylight savings**


For as long as our culture has being making art death, dying, and exploring the meaning of our fragile mortal lives have been key themes.  Historically the arts have framed our practices around preparing for dying, celebrating lives, and pondered the traverse into the unknown.  Artists of antiquity often used their media to describe the care for the dying and the dead, reflecting a palliative focus of the arts which continues to this day.


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#ANZSPM16 Wrap up

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Days two and three of the Australian and New Zealand Society of Palliative Medicine (ANZSPM) 2016 Conference: The Changing Landscape of Palliative Care was just as brilliant as the first. The plenary sessions featured:

  • Merryn Gott (@MerrynGott) spoke about the ‘last taboo’ in our community: the invisible and sometimes unexpected costs of providing care at the end of life, which are often not explored in clinical and almost never measured in policymaking and research. She also discussed  the impact of culture, ethnicity and gender on who is bearing these financial and non-financial costs. To find our more, read her open access @PalliativeMedJ article here.
  • Meera Agar (@meera_agar) discussed the growing evidence base around delirium care in the palliative care setting. Management of this complex, distressing, life-threatening, but often reversible syndrome is challenging. Non-pharmacological strategies and a system-wide approach to organizing and delivering care are crucial, as research into various drug treatments continue to demonstrate a lack of clear benefit and the potential for harm. Meera recommends iDelirium for more information about this important area of palliative care.
  • Pippa Hawley reflected on the lack of evidence around the use of medicinal cannabis – despite the immense interest from (and considerable experience of) our communities. How should clinicians respond while the scientific and legal issues are sorted out? Ask questions, keep an open mind & work with our patients!
  • Douglas McGregor explored the interface between heart failure and palliative care. He referenced Sarah Goodlin’s open access article, Merryn Gott’s study while discussing prognostic uncertainty and clinician paralysis; and observed that most guidelines still see palliative care as relevant only at the very end of life, rather than a key component of chronic disease management. Amy Gadaud’s (@agadoudreview was flagged as a good place to start when considering issues around early integration.
  • Sam Bloore stimulated and inspired delegates with his fascinating talk about dying well in a culture of bitcoin and botox. How can palliative care adapt, survive and thrive in this changing cultural landscape characterized by information overload, mindless distraction and incoherence? We must remain a “subversive” counterculture and continue to strive towards caring deeply and meaningfully!

In addition to these amazing plenaries, fully (and at times even over-)subscribed workshops on the overlap between palliative care and addiction medicine / chronic pain, aged care, literature and the arts were held, alongside numerous excellent oral and poster presentations from specialists and trainees. The enthusiastic and well-informed audience present during all of the sessions was another highlight for me (and I’m sure all of the other speakers and delegates)!

It’s been a wonderful few days in Perth. A big thank you to the Conference organizing committee, chaired by Derek Eng (@dr_engd), for inviting team @Palliverse to be part of this great event. Thanks also to all of you for engaging with #ANZSPM16 on social media. Keep an eye out for our upcoming tweet chats, during which we will continue the conversation about the changing landscape of palliative care!