LAST month, the Health Issues Centre displayed a life-like model of a dying elderly woman in a hospital bed on Melbourne’s Southbank.
The project’s aim was to encourage Australians to have a discussion about improving end-of-life care.
“Our research has shown that people are in denial about what’s going to come ahead,” project co-ordinator and senior policy advisor at HIC, Zoe Austin-Crowe said.
“One of our worries is that people have become complacent in thinking that voluntary assisted dying will be available to them.”
Bioethicist Fr Kevin McGovern is an authority on the ethical implications of euthanasia and end-of-life care.
“When you’re talking about end-of-life choices, one of the things you talk with people about is, ‘What is most important to you’?” Fr McGovern said.
“It’s surprising how few people say, ‘What’s most important for me is to go to the hospital every other day and spend four hours waiting around for a doctor’.
“That’s an important thing to establish – what’s most important to the person?
“A person who’s in their late 80s whose had a good life may well say, ‘The treatment you’re proposing is too burdensome for me’; but another person who’s a young mother (with) two young children might say, ‘Every day I have with my children is so precious to me and I’m prepared to try this hard treatment just in the hope that it gives me a few more months of life’.
“So the person decides.
“It’s not a medical judgement it’s a personal judgement.
“The Church’s teaching, which is a realist teaching, recognises that we aren’t all heroes.
“If something’s just going to be too hard, we’re able to refuse it and instead look to modes of treatments that look towards maximising the person’s quality of life to make sure that the person is in as good a condition as they can be.
“The Church uses what is really the traditional distinction in western medicine between what we sometimes call ordinary and extraordinary means.
“The Church says we’re required to use the ordinary means of preserving life, but we’re not required to use the extraordinary means.
“If someone was otherwise in good health but they needed to take a tablet each day to keep themselves alive and if they didn’t take that tablet they would die in a couple of days, then the Church would say that’s an ordinary means of preserving life.
“It’s effective and it’s not overly burdensome to take a tablet, so someone should reasonably do that.
“Something being extraordinary means that it’s reasonably unlikely to bring about any good results. The word they use for it is ‘futile’.
“It does come down to a point in medicine sometimes where they say ‘This is probably the last treatment option we can think of, it hasn’t got a great chance of succeeding and it’s going to make you really sick and really uncomfortable’.
“In those circumstances someone might say, ‘Listen, I don’t think I want that treatment’.
“I always say to Catholic people, if the treatment is futile it can be refused.”
Fr McGovern said there were often misconceptions about palliative care.
“Sometimes when people hear ‘palliative care’ they think it means end-of-life care; they think palliative care is just for the last couple of weeks of life.
“It’s not – it could be for years, and it could be in conjunction with treatment that’s trying to cure the person.
“It’s any treatment where the focus is on managing distressing symptoms and working with the person so that they enjoy the best quality of life.
“Catholic Health and aged-care has invested significantly in palliative care – certainly in the early days of running and setting up palliative care in Australia.
“The reality is that access to palliative care is very patchy.
“In the big cities you’ll probably be able to find adequate palliative care, but you may have to struggle a bit depending on who your access points are.”
Fr McGovern, who also lectures in Moral Theology at the Catholic Theological College, Melbourne, also warned of the dangers associated with voluntary assisted dying – a euphemism for euthanasia.
“How do you exactly know how long someone’s got?” he said.
“You think that someone’s coming to the end of their life and they actually go on for another five years.
“Those of us who are opposed to euthanasia are concerned that over time the number of folk for whom (assisted dying) will be available will increase.
“Once you say there are some circumstances where it is a benefit to the person to end their life, how can you restrict that?
“If you’re saying this is a good thing for some people, how can you reasonably say that it’s a good thing only for a very small group of people?”
The Voluntary Assisted Dying Act (2017) stipulates that a person must have a disease, illness or medical condition that is neurodegenerative, and “is expected to cause death between 6-12 months” to be eligible for the method.
“If someone says, ‘I’m not dying within 6-12 months, but my life is very distressing to me at the moment and it’s not fair that you’re depriving me of this good, then you can understand how under that pressure voluntary assisted dying will certainly spread out to more people.
“If it is simply a matter of choice, then logically it could extend out to any competent adult.
“What they call ‘informed consent’ is actually a very narrow thing.
“Basically, they say you’ve got to request it, you’ve got to be informed about the options, you’ve got to wait a period of time, you’ve got to request it again in writing and then another time you’ve got to confirm it.
“All of that takes place within less than a week.
“So what they’re calling informed consent is basically saying, ‘well this was my view for a week’.
“I think this whole idea of coming to see the idea of helping someone to end (his or her) life, as a good service to provide, is very, very dangerous.
“The fact that someone says ‘this is what I want for a week’, you can never be sure that that’s his or her settled view.
“I’ve heard so many stories of people who just felt that their life was meaningless who, through the care of other people, have suddenly discovered meaning and purpose in their life again.
“It’s sometimes very simple things.
“If someone comes to my colleagues who are health professionals in this area and says, ‘have you got something that could help me to bring about my death’, wise health professionals will say that something’s not going well in that person’s life.
“It might be pain that we’re not managing, it might be psychological distress about something, they might be scared that they’re a burden on their family, or it might be a sense of social isolation.
“It might be something spiritual.
“I knew someone once who had done a few bad things in the past and they were very afraid of what would happen when they finally stood before God to give an account of their life.
“It was an interesting case because the person presented with unmanageable physical pain, and it took the palliative care team a long time to try and reduce the pain.
“One of the wise health professionals sat down with them and said, ‘we believe in the concept of total pain, where all the pain gets mixed up together, and sometimes what’s psychological, or social, or spiritual pain comes out as physical pain, so is there anything else that’s going on in your life that may be a factor?
“Eventually, with a bit of prompting, the person said they were very afraid of going before God, so a spiritual care practitioner was called in, who was a priest, and he really helped them to make their confession and gave them absolution.
“Once that had happened, the physical pain was quite manageable.”