Palliative care is one of the great overlooked issues in the euthanasia debate. What the terminally ill want and need is pain relief, not an end to life. While suffering certainly exists, so too does substantial hope for healing and wellbeing. That is what palliative care is all about.
The World Health Organization defines it this way: “The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families….”
Although relatively new, palliative care has made tremendous advances in recent years. Yet it is still under-utilised. One medical doctor has said that between 50 and 75 per cent of cancer patients’ pain is under-treated, even by specialists.
But palliative care, if used, can now relieve suffering in the majority of cases. As a pro-euthanasia doctor in Holland, Dr Peter Admiraal, has admitted, “essentially all pain can be controlled … euthanasia for pain relief is unethical”. One doctor has said that “there is no pain that I cannot treat”. Perhaps 95 per cent of all patients can find relief from palliative care.
Dr Ian Gawler has said, “in many years of working with people facing death I have never been confronted by a situation where the urge to provide ongoing compassionate care was outweighed by the pragmatic need for a prematurely induced death.” And a doctor from Western Australia has said, “there are very few symptoms indeed which cannot be controlled through the application of good palliative care”.
Those who work with dying people know that the overwhelming majority want their pain controlled, but do not want to be killed. Paul Dunne, who has worked with over 1,000 dying patients in Hobart, has said that only five patients have ever said, “Kill me”.
As Rae and Cox point out, “Physicians have at their disposal today the means to adequately control the pain of virtually every patient who is terminally ill. . . . Hospices specialize in the art of pain control particularly for the terminally ill. Far too many people die in hospitals, pursuing aggressive care, when they could be spending their last days with their pain under control, their depression (from being terminally ill) being treated, and not subject to expensive and burdensome aggressive medical technology.”
Larson and Amundsen summarise: “As a result of work by Cicely Saunders and other experts in the field of pain management, nearly all terminally ill patients can obtain sufficient relief from their physical pain. That is the purpose of hospice – and it works. Based on her years of experience treating dying patients with proper pain management at her hospice in London, Saunders reports that none of them have asked for physician-assisted suicide or euthanasia.”
Medical treatments and dedicated care need to go together. As one instructor in clinical medicine says, “Aggressive chemotherapy must be accompanied by aggressive pain and symptom management and careful psychosocial and spiritual support. Studies have shown that patients who are physically comfortable and whose emotional and spiritual needs are addressed have a better quality of life, are more satisfied with their care, and are more likely to be able to cooperate with other therapies.”
But when the emphasis is on killing patients instead of caring for them, then there will be less interest in, and funding for, things like palliative care. The unanimous report of the House of Lords Select Committee on Medical Ethics has recommended that there be no change to law in the United Kingdom to permit euthanasia. More and better palliative care was instead recommended. Not surprisingly, there is a clear lack of substantial palliative care in Holland.
Says philosophy professor Mark Foreman “according to a study of the British Medical Association, the state of palliative care and hospice care in Holland is very poor. Where euthanasia is an accepted medical solution to patients’ pain and suffering, there is little incentive to develop programs which provide modern effective pain control for patients.”
Indeed, as euthanasia becomes legal and accepted by the community, there will be an inevitable lessening of interest in palliative care and the care of the elderly. As Dr John Buchanan put it, “A risk of the denial of the right to palliative care may arise for those who do not wish to request euthanasia”. Indeed, when “death is seen as a treatment, then medicine will allocate more and more resources to develop the technological advances to improve this treatment.”
Australian author Lisa Birnie concurs. As she began writing her book on death and dying, she had an open mind on the issue of euthanasia, but she ended up recognising its many inherent dangers. She is now a strong supporter of palliative care, and regards the legalisation of euthanasia as “a form of social suicide”.
She writes, “I am … convinced that the research required to find the solution to extreme pain in all cases will never be done if euthanasia is permitted simply because it is the cheapest and easiest solution in a world where health budgets are tight, solutions are judged by practical results, and moral standards are determined, essentially, by expediency”.
Instead of concentrating all of our efforts on killing the sufferer, what any compassionate and humane society should do is concentrate on relieving the pain of the sufferer. So the next time someone from the pro-euthanasia camp starts going on about compassion and caring, ask them what they are doing to support palliative care.
As Australian palliative care expert Brian Pollard has written, “In medical practice, it is never necessary to kill a person to relieve physical pain.”
I conclude with an extended quote from Donald De Marco: “Rejecting the Culture of Death does not mean a blanket acceptance of health care in its present form. It should be axiomatic that we need to improve our treatment of the terminally ill; the chronically sick; and all others who suffer from physical, psychological, or personal problems. But if we choose to kill, we will foreclose the possibilities of these improvements.
“A Culture of Life is a Culture of Care. And care goes well beyond medical treatment. It includes a multitude of ministries that flow from human love. Helping the needy in this matter includes bringing them hope, affirming their dignity, reassuring them that their lives have meaning, reminding them of their honored place in the community, and letting them know that they are loved.
“Those who advance the Culture of Death provide a profound disservice to humanity in two ways – by promoting death and by ignoring or interfering with services of care. The Culture of Life will succeed only to the extent that all people are working for the same end.”