I’ve been time travelling in my own head in recent weeks. Why is it so important to do the right thing for me? This follows a busy month with a number of conference presentations which led to a roller-coaster of emotions. The highs of being with like-minded individuals and being accepted by my new tribe. The lows of being iced by some members of my old tribe. A time to reflect on my experience of being ‘the other’. Children do not choose where they are born or to which family they belong to. They have no choice in the matter. The process of conception is close to miraculous, two tiny collections of DNA are joined together and become an unique recipe for a potential human being. Nine months of incubation later and the accident of birth occurs.
I would find it too morally distressing to send one of my dying patients out of my hospice to the other side of the city to have their assisted death. I wonder if other hospice and palliative care team members share similar feelings. I know definitely that some members of other teams have no qualms about discharging their patients home for assisted death. What about patients who don’t have a home of their own, or who are unable to be home for their assisted death? Where can they go? Unfortunately, the answer from other hospice teams has been, “Anywhere but here.” This is a situation known as a forced transfer, something I have encountered many times in the past almost three years since assisted dying became legal in New Zealand, and we started hosting assisted deaths.
Some of these team members also have no qualms about sending a patient, known to be in their last hours of life before an assisted death, into rush hour traffic. Maybe the same team members have made it clear to the patient and family what their personal views are about the choice the patient has made. The dying person on the receiving end may feel judged and even more vulnerable. What happened to the care part of palliative care? Everyone is entitled to their opinions but when you are at work patients deserve to be met with staff members’ best professional selves, not their strongest personal opinions. For some team members even talking about assisted dying makes them feel uncomfortable, and they share this discomfort with the patients they are supposed to be caring for. Do the staff feel uncomfortable? What about the person who is dying? Can we please treat people with compassion and humanity? How would you feel if you were on the other side of the bed?
This was a question that came to mind after a past colleague theorised about changing a patient’s prognosis to more than six months left to live to stop them from accessing the assisted dying service. I was shocked that they would consider doing something like that. In plain English, it would be telling a lie. Lying to a patient and not giving them your true medical opinion. An opinion that required at least 13 years of training to develop, but one they could consider defiling by not telling the truth. To me, this was wrong on many levels and was one of the main reasons I didn’t miss the ex-colleague much.
Honesty is something our patients deserve. We need to let them know what is going on to the best of our abilities. We are not fortune-tellers and we cannot predict the future but we can provide our best educated guess. People usually want to know how much time they have left as it puts a lot of things into perspective. It makes them focus on what is really important to them. Who is important to them, and who they want to spend their precious time with. What things do they still need to complete given the limited time left? Where they draw the line. What is too much for them to handle? To rob them of these opportunities is wrong.
A person’s prognosis is not owned by the doctor, it is the patient’s prognosis, not their family’s, or their parents’ or children’s. It is their own prognosis. They can do what they like with the information. It is their property and can be used as they see fit. To deny someone the truth about their end of life is such a bad thing to do. You might not agree with what a patient, or what another person chooses, but that does not give you the right to sabotage their plans. They have already lost so much control of their life and a so-called professional would try to stop them from attaining a dying wish.
We are supposed to provide patient-centred care, not doctor-centred care. We exist to serve our patients. They do not exist just to provide us with work, they have lives of their own, stories of their own. It is not about us. Palliative care is supposed to be focused on the needs of the patients and not the needs of the providers. Anything else is just wacko.
[The following essay by Dr Adrian Dabscheck, an experienced palliative care physician in Melbourne, explores the evolution of our society’s views towards death and reflects on the role of palliative care and voluntary assisted dying in this context – Chi]
During a recent period of enforced rest, I had time to reflect on my attitude to the recently enacted voluntary assisted dying legislation in Victoria and consider my response.1 I will detail my reaction to the Act and why I have chosen to become a so-called conscientious objector.
In his essay Western Attitudes Toward Death,2 French historian Philippe Ariès illustrates the evolution of our attitudes to death.
Initially, and for millennia, there had been a general resignation to the destiny of our species for which he used the phrase, Et moriemur, and we shall all die. This was replaced in the twelfth century by the more modern concept of the importance of one’s self, and he used the phrase, la mort de soi, one’s own death. Continue reading →
palliverse.com 