Monday, 3 June 2013
Contacts for Palliative Care and for Euthanasia in Australia
- Palliative Care Australia. This is the peak national body for Palliative Care: www.palliativecare.org.au/
- Exit International represents the most cohesive credible and respectful form of expertise for Euthanasia in Australia:
Hospice Bridge - Reflections of Palliative Care/Chapter three/John Fitzpatrick copyright please 2013
Chapter Three
Jacinta Arrack
Finishing my ‘Basic Nursing Studies’ in 1986 (a few months after my colleagues
due to the fact that I had a habit of wandering off into the mountains rather
than always turning up for a shift that started before ‘freezing-seven’ in the
morning), I undertook a course in ‘Post-Basic’ studies in Aged Care and
Palliative Care at that local Hospice/Home.
Now, as to my studies in ‘Post Basic’ Palliative Care at the local
Hospice/Home…Many people died at that local Hospice/Home, as you would expect.
One person, in particular, did not. One proud and matronly figure, Mrs Jacinta
Arrack, had been given a prognosis of three months. She was a smart,
deliberative and purposeful woman. She was about sixty years old.
She ‘put her accounts in order’. She
was organised. She handed over her house and another rambling property to her
son.
She said all of her heartfelt goodbyes. She asked for no one to visit her
as she did not want to be seen by people that she loved as she deteriorated
over the prescribed time, give or take. Fine. Done.
The beloved son went overseas and married the most beautiful woman I have
ever seen, from Iran
It was as if that is why gold was created in the first place. At last,
here on earth, real gold had some real meaning, to highlight the beauty of
human skin. The same went for the bothersome sounds of the clunking diamonds. A
kind of ethereal music… like spectral shimmering, wind-chimes.
Why bother to grow a giant forest if not to compress it for countless hundreds
of thousands of years into carbon, and then to add heat and pressure and time
to turn it all into diamonds?
Why do that if it was not to somehow add even more beauty to this young
woman’s constant emanation in the world? Why bother do all that if it was not
for this one?
It did us all good to see this magnificent extravagance of young human
reality somehow conjugated into one being who stood five foot ten inches tall,
in full black-silk adornment, and with high golden heels. It always will do us
good to see this. Beauty is awesome.
Sorry, I digressed from Palliative Care and death for
a moment…
It’s just something I’ve noticed. That sometimes there are some people
who are so dynamically and dazzlingly beautiful, whether of body or mind or
spirit, that you can’t actually see them.
You can’t actually see them clearly at all, but it’s very hard to look away.
Your eyes are drawn into a milieu of fascination and the beauty is so
transcendent, so transforming, that by seeing this being, you are changed, in
yourself, without any clarity or understanding coming with it at all. Blink. My
goodness, it’s so easy to digress from Palliative Care for a moment.
Anyway, meanwhile, back in the Hospice, after six months… three decent
months after she was supposed to be very dead, Mrs Jacinta Arrack, well, she
was looking very well indeed. If this
was deterioration, based on legitimate cancer process and trajectory, then I
wish it for us all. Mrs Arrack was aglow with life.
As it happened, her diagnosis was an error of medical judgment. Reviews
were flawed. Tests were mislaid. Misinterpreted. Someone else’s files. Oops. It
happens more often than it should, just like everything else. It was a human
error. It must happen. It’s human. You can and can’t depend on it.
Meanwhile, her grand home and remnant bucolic pastoral properties had
been sold off by her son and he invested all of that into having the continuity
of human beauty and meaning with him, loving him, every day. He was deeply in
love with his wife, and she with him.
The somewhat bedazzled son came to visit his mother upon hearing the good
news of her new extended-term on Earth. She had to leave the Hospice. She had
to go home. For the first time in her strong life, she had no home. He, her
best beloved, had sold it. He skulked around her Hospice room like a wide-eyed scared
miniature fox terrier with an anxiety disorder.
As for Mrs Jacinta Arrack, well, she, who up to that time thought she was
nigh upon approaching full heaven, when faced with the life-changing decisions
of her goodly son, well, she gave him full hell. She also had quite a few
unpleasant words for the man’s bejewelled Iranian wife.
This is one of the problems with wishing for an instant cure for
everyone. You’d end up with quite a few folk wandering the streets with nowhere
to live; really annoyed at their children. Some would even have vague plans of
attacking the good people of Iran
4: Palliative care & Euthanasia/ A Word About Hospice
The word Hospice has gone out of fashion in many places but the best human care I have ever seen and participated in, in Palliative Care, have been in Hospices. The worst care I have ever seen has been in Units where Palliative Care is co-joined to Oncology Services.
I really have never seen such human suffering in all my life more than is in Oncology Units pretending they are doing end of life Palliative Care. I find this to be one of the most disgraceful misrepresentations of human care I have ever seen, and it happens on a daily basis because the Mind-set, the curative, life-extending mindset of Oncology Services really never knows when enough is enough until someone is in the ground.
I'm sure, if they could, Oncological Services would develop radiation treatment via jump-start-leads into graves... if they could...and call it Palliative Radiation......or have vials of mustard gas poured into the trenches.
Oncology Services in Australia are presently trying very hard to re-name Palliative care as Supportive Care basically so they can have access to the money to irradiate and poison even more people up to the day they die.
The more end-of-life care is moving towards the Hospice ideal, the better it gets for the patient, family and staff. The more it moves towards streamlined integration with curative and chronic health services, the worse the care gets.
Thirty years working in palliative care and only a few really horrific stories to tell, and all related to far too much surgery, radiation, and chemical poisoning of some very nice and pleasant and easy-going good people whose only real illness, apart from some nasty cancers, were that they were privately insured and trusted their Oncologists implicitly.
True. Fact. No doubt about that.
It is often said that no one goes to work in the Health Services with the idea of actively hurting people, and this is quite often the case; but there are times and people who do hurt and punish the most vulnerable quite purposefully. I've seen this happen in hospitals, less often in palliative care units, and hardly ever in hospices, but it does happen; not everyone is a decent human being at all, no matter what their skills and qualifications. We need to keep our wits about us as to whom to trust in every aspect of life.
I really have never seen such human suffering in all my life more than is in Oncology Units pretending they are doing end of life Palliative Care. I find this to be one of the most disgraceful misrepresentations of human care I have ever seen, and it happens on a daily basis because the Mind-set, the curative, life-extending mindset of Oncology Services really never knows when enough is enough until someone is in the ground.
I'm sure, if they could, Oncological Services would develop radiation treatment via jump-start-leads into graves... if they could...and call it Palliative Radiation......or have vials of mustard gas poured into the trenches.
Oncology Services in Australia are presently trying very hard to re-name Palliative care as Supportive Care basically so they can have access to the money to irradiate and poison even more people up to the day they die.
The more end-of-life care is moving towards the Hospice ideal, the better it gets for the patient, family and staff. The more it moves towards streamlined integration with curative and chronic health services, the worse the care gets.
Thirty years working in palliative care and only a few really horrific stories to tell, and all related to far too much surgery, radiation, and chemical poisoning of some very nice and pleasant and easy-going good people whose only real illness, apart from some nasty cancers, were that they were privately insured and trusted their Oncologists implicitly.
True. Fact. No doubt about that.
It is often said that no one goes to work in the Health Services with the idea of actively hurting people, and this is quite often the case; but there are times and people who do hurt and punish the most vulnerable quite purposefully. I've seen this happen in hospitals, less often in palliative care units, and hardly ever in hospices, but it does happen; not everyone is a decent human being at all, no matter what their skills and qualifications. We need to keep our wits about us as to whom to trust in every aspect of life.
3: Palliative Care & Euthanasia/ Cross Referrals
So, when looking at the Doctrine of Double Effect, the thing that comes through is the Motivation for the Action. In this way the Doctrine reflects most human laws in most countries in regard to harm to self or another.
It is not the action, so much, but rather the Motive.
Usually for anything to be 'a crime' there in fact needs to be a Motive to commit a crime.
The Motive in Palliative Care is to render the person free of suffering as they have requested.
The Motive in Euthanasia is to kill the person as they have requested.
Personally, I can see nothing wrong with either Palliative Care or Euthanasia in my own view, but I do understand that one is legal and the other is illegal. I feel both should be legal. I can see nothing wrong in a scenario where referrals between Palliative care and Euthanasia Services can be made, and vice versa, to best meet the requirements and desires of the person.
Personally, I have found the 30 years working in clinical end-of-life Palliative Care to have been naturally burdensome and I would find it pretty well impossible to be at peace working in a Euthanasia Clinic for any length of time.
I believe the 'weight' of such decisions and events is very heavy and to work in a Euthanasia Clinic, well, that would have to be a very highly paid job, with strong debriefing support, and there would have to be a lot of holidays. Mind you, I feel that way about working in Palliative care anyway...but there are differences, to me.
It is not the action, so much, but rather the Motive.
Usually for anything to be 'a crime' there in fact needs to be a Motive to commit a crime.
The Motive in Palliative Care is to render the person free of suffering as they have requested.
The Motive in Euthanasia is to kill the person as they have requested.
Personally, I can see nothing wrong with either Palliative Care or Euthanasia in my own view, but I do understand that one is legal and the other is illegal. I feel both should be legal. I can see nothing wrong in a scenario where referrals between Palliative care and Euthanasia Services can be made, and vice versa, to best meet the requirements and desires of the person.
Personally, I have found the 30 years working in clinical end-of-life Palliative Care to have been naturally burdensome and I would find it pretty well impossible to be at peace working in a Euthanasia Clinic for any length of time.
I believe the 'weight' of such decisions and events is very heavy and to work in a Euthanasia Clinic, well, that would have to be a very highly paid job, with strong debriefing support, and there would have to be a lot of holidays. Mind you, I feel that way about working in Palliative care anyway...but there are differences, to me.
2: Palliative Care & Euthanasia & the Doctrine of Double Effect
The Doctrine (or principle) of Double Effect is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end. It is claimed that sometimes it is permissible to cause such a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end. This reasoning is summarized with the claim that sometimes it is permissible to bring about as a merely foreseen side effect a harmful event that it would be impermissible to bring about intentionally.
It is a fascinating Doctrine in that whilst on the surface it applies in Palliative Care sometimes, it also applies to bombing cities as well.
This 'doctrine' came from the work of Thomas Aquinas and many applications of this DDE can be illustrated thusly:
Many morally reflective people have been persuaded that something along the lines of double effect must be correct. No doubt this is because at least some of the examples cited as illustrations of DE have considerable intuitive appeal:
It is a fascinating Doctrine in that whilst on the surface it applies in Palliative Care sometimes, it also applies to bombing cities as well.
This 'doctrine' came from the work of Thomas Aquinas and many applications of this DDE can be illustrated thusly:
Many morally reflective people have been persuaded that something along the lines of double effect must be correct. No doubt this is because at least some of the examples cited as illustrations of DE have considerable intuitive appeal:
- The terror bomber aims to bring about civilian deaths in order to weaken the resolve of the enemy: when his bombs kill civilians this is a consequence that he intends. The tactical bomber aims at military targets while foreseeing that bombing such targets will cause civilian deaths. When his bombs kill civilians this is a foreseen but unintended consequence of his actions. Even if it is equally certain that the two bombers will cause the same number of civilian deaths, terror bombing is impermissible while tactical bombing is permissible.
- A doctor who intends to hasten the death of a terminally ill patient by injecting a large dose of morphine would act impermissibly because he intends to bring about the patient's death. However, a doctor who intended to relieve the patient's pain with that same dose and merely foresaw the hastening of the patient's death would act permissibly. (The mistaken assumption that the use of opioid drugs for pain relief tends to hasten death is discussed below in section 5.)
- A doctor who believed that abortion was wrong, even in order to save the mother's life, might nevertheless consistently believe that it would be permissible to perform a hysterectomy on a pregnant woman with cancer. In carrying out the hysterectomy, the doctor would aim to save the woman's life while merely foreseeing the death of the fetus. Performing an abortion, by contrast, would involve intending to kill the fetus as a means to saving the mother.
- To kill a person whom you know to be plotting to kill you would be impermissible because it would be a case of intentional killing; however, to strike in self-defense against an aggressor is permissible, even if one foresees that the blow by which one defends oneself will be fatal.
- It would be wrong to throw someone into the path of a runaway trolley in order to stop it and keep it from hitting five people on the track ahead; that would involve intending harm to the one as a means of saving the five. But it would be permissible to divert a runaway trolley onto a track holding one and away from a track holding five: in that case one foresees the death of the one as a side effect of saving the five but one does not intend it.
- Sacrificing one's own life in order to save the lives of others can be distinguished from suicide by characterizing the agent's intention: a soldier who throws himself on a live grenade intends to shield others from its blast and merely foresees his own death; by contrast, a person who commits suicide intends to bring his or her own life to an end.
1: Palliative Care & Euthanasia/ An Understanding of Differences
I wish to put some ideas here in these pages regarding the interface and the differences between Palliative Care and Euthanasia in a sensible and serious way in the next few days.
For the purposes of the topic, I will make a clear distinction that what I am talking about is Voluntary Euthanasia and, indeed, Voluntary Palliative Care, so I am not talking about having these therapies decided or imposed by well-meaning or not well-meaning others, simply because there are too many distractions once we enter that discussion.
Often the discussions can be skewed by people with a specific ideological or religious agenda, and the topic is too serious and meaningful to allow this casual and mischievous distraction.
So, to start with a simple definition of Palliative Care:
Palliative Care is care and therapies established for a person to deal with the pain and symptoms involved with a life taking incurable illness. Often this is noted as specifically related to cancer, but this is untrue. It is any progressive incurable life taking illness which does, in fact, take life, and, indeed, doesn't give it back.
The object of Palliative Care is the removal or ablation of distress and pain usually within the last 3 months of life, based upon sensible understanding of disease trajectory...and there is very little mystery involved with disease trajectory, really.
In this way Palliative Care is really defined by its motivation: to alleviate, prevent, treat, assuage and .ameliorate distressing symptoms during the progression of disease to the death end point, and to also provide care and support for family, friends etc during and after the process. The Motivation is clear. To make life liveable whilst life endures without imposing pointless interventions onto the person in terms of invasive curative therapies when the illness is not curable.
Euthanasia, on the other hand has a different motivation, which is to end the life of the person based upon their decision, in a clear and timely fashion chosen by the person. So, the Motivation in Euthanasia is to bring about the death of the person in accordance with their wishes.
For the purposes of the topic, I will make a clear distinction that what I am talking about is Voluntary Euthanasia and, indeed, Voluntary Palliative Care, so I am not talking about having these therapies decided or imposed by well-meaning or not well-meaning others, simply because there are too many distractions once we enter that discussion.
Often the discussions can be skewed by people with a specific ideological or religious agenda, and the topic is too serious and meaningful to allow this casual and mischievous distraction.
So, to start with a simple definition of Palliative Care:
Palliative Care is care and therapies established for a person to deal with the pain and symptoms involved with a life taking incurable illness. Often this is noted as specifically related to cancer, but this is untrue. It is any progressive incurable life taking illness which does, in fact, take life, and, indeed, doesn't give it back.
The object of Palliative Care is the removal or ablation of distress and pain usually within the last 3 months of life, based upon sensible understanding of disease trajectory...and there is very little mystery involved with disease trajectory, really.
In this way Palliative Care is really defined by its motivation: to alleviate, prevent, treat, assuage and .ameliorate distressing symptoms during the progression of disease to the death end point, and to also provide care and support for family, friends etc during and after the process. The Motivation is clear. To make life liveable whilst life endures without imposing pointless interventions onto the person in terms of invasive curative therapies when the illness is not curable.
Euthanasia, on the other hand has a different motivation, which is to end the life of the person based upon their decision, in a clear and timely fashion chosen by the person. So, the Motivation in Euthanasia is to bring about the death of the person in accordance with their wishes.
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