Wednesday, January 24, 2001 


Vulnerable patients fear being pressured into an early death

 By Julie Robotham, Medical Writer 

Terminally ill patients are terrified they may be pressured to hasten their deaths as a result of community acceptance of medically assisted euthanasia, a doctors' group says.

"This is a vulnerable population who want to leave a legacy. To make every person who's facing death think about euthanasia is an enormous impost on people who are already feeling isolated and frightened," said the vice-president of Palliative Care Australia, Professor David Currow.

"The biggest issue for me is that I need to be able to say to patients that I am not shortening their life. It's an overwhelming fear they have."

Professor Currow said about one patient a month raised the issue of euthanasia, but these were usually "episodes when people want to be heard", and the person later said they were glad they had not died at that time.

Voicing a desire for euthanasia was often a means of expressing their isolation to their family.

About 20,000 people die in Australia annually under the care of palliative care teams, and up to one-third of those die in their homes.

Professor Currow said 85 per cent of palliative care patients had advanced cancer. People with HIV/AIDS, motor neurone disease or multiple sclerosis, or final-stage heart or kidney failure, accounted for most of the others.

Although those who chose to die at home needed full access to medication to keep them comfortable, it was very difficult for palliative care patients to overdose on morphine, Professor Currow said.

This was because their bodies developed an increasing tolerance to high quantities of the drug. "Palliative care does not include deliberately ending life."

Professor Currow's comments come as other medical groups consider a softer approach to medical involvement in death.

The NSW Cancer Council is discussing the adoption of a new position statement that would read: "NSW Cancer Council does not support interventions that have as their primary goal the ending of a person's life, but endorses the right of a severely or terminally ill patient to have relief of pain and suffering, even when such therapy may shorten a person's life."

The council said it would seek further community consultation before deciding whether to adopt the policy.

The council's manager of cancer services, Ms Louise Burton, said medical intervention in death happened "more often than we are aware of"'.

She said dying people needed access to their own medication even if it was potentially lethal, because "patients need to have control. Ideally, pain will be well controlled but we realise some people will not achieve optimal pain control."

Morphine was only one among a range of therapies that could include nerve blocks such as epidurals or slow-release drug patches, Ms Burton said.

A 1996 study of deaths in Australia concluded that 30 per cent of all deaths are "intentionally accelerated by a doctor" - by means such as withholding of further treatment.

The research, published in the Medical Journal of Australia, found that in only 4 per cent of cases was the action in direct response to a request from the patient.



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