By Laura Banks
Just before his 21st birthday, Carl Molkner was told he had six months to live. An aggressive tumour had made a home in his head and neck, and treatment was having no effect.
The cancerous tumour was pushing on the nerves in Molkner’s face, causing unbearable pain, his quality of life was waning and his desire to give up was growing. He had dreams of being a chef and travelling the world, but his future dissolved after that painful conversation.
Carl Molkner was in palliative care at the start of the year for an incurable malignant tumour in his head and neck. Midway through the year, a surgeon successfully operated to remove the tumour.Credit: James Brickwood
If voluntary assisted dying were an option available to Molkner a year ago, he says he may have considered it. VAD begins in NSW next week.
Molkner, from Sydney’s northern beaches, was “off and on” in hospital, under the care of palliative specialists at Chris O’Brien Lifehouse. The nurses, Molkner said, became his lifeline.
“Having that care from the nurses completely impacted where I am now,” he said. “When I began to lose hope and give up, these really special people pulled me back up – they were my confidence when I had none.”
It was that confidence that led the 21-year-old back to a surgeon who had previously declined to try risky surgery that had the potential to save his life.
“Luckily, he put his hand up after originally saying no. There was now nothing left to lose, so he said he would give it a shot and I went on the table for 11 hours,” Molkner said.
The surgery was a success and Molkner is in remission. He believes with the introduction of voluntary assisted dying, others who find themselves in a similar situation and who cannot access adequate palliative care, may choose euthanasia.
“The last 18 months have been a hell of a ride,” he said. “The mental battle is just as important as the physical battle when going through a life-altering illness. As soon as you lose hope, you’ll lose everything.”
The state’s local health districts have been forced to reduce their planned spending on palliative care following a $150 million budget cut by the state government for end-of-life care. The money has been redirected to boost the broader nursing workforce and the palliative care spend has been shrunk from $1.85 billion over four years to $1.7 billion.
The cuts coincide with the legalisation of voluntary assisted dying in NSW. Terminally ill adults experiencing “intolerable suffering” will be able to apply to end their lives from November 28. The first patients will be able to take a VAD substance five days later.
Dr Philip Lee, a retired palliative care physician and former director of supportive and palliative medicine at Western Sydney Local Health District, said “inadequate” end-of-life care provisions would force people into euthanasia.
“There’s been two or three studies done which looked at patients being admitted into palliative care units; they documented those patients who requested euthanasia,” Lee said. “They reviewed them 48 hours later and less than 4 per cent of that group still requested euthanasia because their quality of life issues had been resolved.
“If you don’t have the resources to meet the quality of life needs of palliative care patients, more patients will be requesting voluntary assisted dying.”
Lee said he had spoken to two palliative care directors who were employed and could not speak out and who had told him that the $150 million cut had equated to 80 per cent of their budgets for this finanical year.
“For one palliative care team, that translates to a $1.2 million cut for this year,” he said.
“That will have a dangerous impact on providing quality palliative care services.”
Opposition health spokesman and former treasurer Matt Kean, who orchestrated the additional funding for palliative care during the debate over the introduction of VAD in the last parliament, said he was launching a campaign to have the budget reinstated.
“The choice I’m most concerned about is a choice facing society. How much is it worth to prevent suffering and give people dignity in their last dying days?” he said.
A NSW government spokesperson said the palliative care budget was 6.8 per cent higher in 2023/24 and would increase again by 8 per cent the following financial year.
“A fundamental part of the legislative framework is that a discussion with a patient about voluntary assisted dying must be part of a broader discussion about other treatment and palliative care options,” the spokesperson said.
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