Opinion: Palliative care to remain vital despite legalised euthanasia

Voluntary assisted dying must not be the be-all-and-end-all on the question of dignity at the end of life, writes Catherine Dhavernas.

This week the Queensland Government will introduce legislation to establish voluntary assisted dying laws. If passed, the Bill could be implemented as early as January 2023, making Queensland the fourth Australian jurisdiction to legalise voluntary assisted dying.

In her announcement of the proposed Bill last week, Premier Palaszczuk spoke of having witnessed the heartbreaking suffering of her grandmother and uncle, and of the importance of giving individuals the choice to end their life with dignity.

The Premier pointed out that while the Bill entailed groundbreaking reform that many Queenslanders would welcome, she understood that there would be deeply felt opposition, and added that proposing the Bill did not mean that palliative care “would not be an option as well”.

Knowing that thousands of Queenslanders currently use its services, the Premier confirmed her Government would invest $171 million in palliative care “to ensure that people have that choice”.

I cannot say what the Premier meant in stating that the Bill would not preclude people from choosing palliative care as another option, but by placing voluntary assisted dying and palliative care in a position of “either/or” options – rather than highlighting how interrelated they can and should be – such phrasing opens a significant gap in the discussion around voluntary assisted dying.

People who might face a voluntary assisted dying decision ought to be in palliative care for the holistic medical care, pain management, social, emotional and spiritual support it will provide for them and their family before, during, and after the decision-making process, if they choose to end their life.

End-of-life issues such as voluntary assisted dying sit along a broad spectrum of forms of care captured under the name “palliative care” – the availability and impact of which are not always fully understood by practitioners or by people and families facing end of life issues.

Before putting forth the option of choosing between voluntary assisted dying and palliative care, it is paramount to further inform people about the important role of palliative care when we face the ends of our lives.

This is so voluntary assisted dying is seen not as the be-all-and-end-all on the question of dignity at the end of life, but as one small part of a much broader and more complex approach to end of life options and care.

Palliative care is for the most part under-utilised, underfunded, too often stigmatised and misunderstood.

As a result, of the many individuals who could benefit from palliative care, proportionately few end up accessing its services. As such, people can find themselves in situations of intolerable suffering which, with the support of palliative care, could have been alleviated or prevented.

A key factor undermining access to palliative care involves a misunderstanding of what palliative care is, whom it is for, and what it involves.

Not only is there a social stigma and lack of public education around palliative care, but general clinical practitioner education programs rarely include training in the field.

For many patients and physicians, “palliative care” signals that there is no hope. In such cases, doctors tend to claim that patients aren’t “ready” for it or else refuse to consider palliative care as an option for fear that their patients will feel that they have given up on them.

Yet this could not be further from the truth. Palliative care involves a holistic team dedicated to maintaining quality of life by providing the medical, social and spiritual support needed to enable patients and their families to focus on living.

Studies have shown that most Australians would prefer to die at home with family. This is something that palliative care is dedicated.

However, doing so requires resources. And as things stand, the $171 million pledged by the government, over a six-year period, represents a mere 10 per cent of the $275 million a year required to provide palliative care to those who need it.

Like any lightning-rod issue, voluntary assisted dying will attract attention, energy and money while there, in the background, working quietly and with grace, palliative care sits, needing funding, public education and social acceptance.

If the Queensland Government wants to give Queenslanders the choice to end their life with dignity, palliative care needs to be central to the discussion that will follow the Bill’s introduction.

Catherine Dhavernas is an Associate Professor at Griffith University’s School of Humanities, and is a volunteer biographer at Karuna Hospice