Voluntary euthanasia debate highlights need for better regional palliative care in Western Australia
Posted September 26, 2019 08:13:22
With Western Australia moving closer to legalising voluntary assisted dying (VAD), the debate is shining a light on the desperate need for better palliative care, particularly in regional areas.
- There are fears VAD laws will restrict choice for people who don’t have adequate access to palliative care
- Specialists say the quality of end-of-life care varies greatly from region to region
- There is a lack of understanding about what palliative care can do in the community, advocates say
Lower House MPs spent about 70 hours debating the VAD bill before passing it on Tuesday, but it is unclear whether there is enough support in the Upper House for it to pass.
Supporters of the law, which would allow terminally ill people the ability to end their own life, argue that it promotes choice and empowerment.
However, there are fears the legislation will restrict choice for people living in the regions who do not have adequate access to palliative care.
Australian Medical Association WA president Andrew Miller said the organisation was extremely concerned.
“We would have failed in this whole conversation, if [VAD] becomes a dying person’s only reasonable option,” he said.
“If they don’t have access to great palliative care, if they don’t have access to great treatment — if that is what they want — but all they have access to is voluntary-assisted dying, then that will not be a good outcome for the regions or anywhere else in our community.”
‘Huge disparity’ from region to region
A study conducted by the WA Palliative Medicine Specialists Group found 73 per cent of people living in the agricultural, mining and pastoral regions believed palliative care should be improved before the introduction of the VAD legislation.
The study also looked at the availability and access to palliative care in the regions, where it found people living in the state’s South West had the best access to services, while those living in the Pilbara had the worst.
Palliative care in regional WA
|Region||Specialist visits per year|
|Kimberley||Six (each visit for one week)|
|Mid-west||10: Geraldton (each visit for one day); Two: Carnarvon|
|Wheatbelt||12 (three each to Northam, Narrogin, Merredin and Moora)|
|Goldfields||12: Kalgoorlie; Four: Esperance|
|South-west||Two resident specialists in Bunbury. No “adequate care” in surrounding towns|
|Great Southern||One resident physician in Albany. Two visits each to Mt Barker, Katanning and Denmark|
Supplied: WA Palliative Medicine Specialists Group
The organisation’s chairman, Anil Tandon, said access to palliative care specialists was not equitable.
“There is a huge disparity from one region to another,” he said.
“Some regions, for example, literally receive only one or two days for the entire year, whereas other regions, for example, Bunbury has two palliative care specialists who live and work in the region.
“We’re talking about choice in this debate on assisted suicide … it is not much choice if you don’t even have choice to receive the best quality end-of-life care.
“If your only choice is euthanasia, well that is not particularly much of a choice.”
New discipline means many misconceptions
What most people seem to agree on is that palliative care is a relatively new discipline of medicine and people still have misconceptions about it.
Brett Hayes, the clinical nurse manager of palliative care in the Wheatbelt, was last year named WA’s nurse/midwife of the year for creating and leading a project that offers palliative care services through Telehealth.
He said 70 per cent of patients expressed their desire to die at home, but at the time of the survey only 13 per cent were able to do so.
The tele-palliative care pilot program increased that number to 44 per cent.
“Our team is quite small and the area we cover is quite big, and we found that video conferencing could address that issue,” Mr Hayes said.
“We found that we could talk to people face to face within five minutes rather than having to drive long distances, and it was quite effective.”
Mr Hayes said one of the biggest issues was people still did not know much about palliative care.
“Most people’s conception is that it is only for people who are dying and it is in the last few days of life, and if you need palliative care then it means you are going to die,” he said.
“Our philosophy is that we help people when they are dying, we don’t hasten their death and we don’t prolong their death, but we help them along that journey.”
Mia Davies, Leader of the Nationals WA, said while more needed to be done to educate the community about palliative care, it had to be properly funded.
“What this whole debate has done is emphasise the fact that we need to increase funding right across the board for palliative care services,” she said.
“There is a distinct lack of understanding about what palliative care can do in the community, and that has been acknowledged through the parliamentary committee report that informed the VAD legislation.”
In the last state budget, more than $30 million was committed for palliative care services in the regions, along with $5 million to help build an aged care facility in Carnarvon.
Health Minister Roger Cook said this was the largest investment in palliative care in the state’s history.
“Palliative care services in WA are a unique blend of hospital and community services, which reflect the demands of the most geographically challenging and isolated health jurisdiction in the world,” he said.
“WA Country Health Services (WACHS) is currently working carefully to ensure equity of access across the seven regions so people can benefit from receiving safe, high-quality palliative care regardless of where they live.
“WACHS has initiated a comprehensive review of existing models of service delivery.
“It is worth noting that Palliative Care Australia has found that in every country that has introduced assisted dying, palliative care services were significantly improved and increased.”
Topics: health, euthanasia, death, health-policy, carers, healthcare-facilities, community-and-society, human-interest, geraldton-6530, albany-6330, bunbury-6230, karratha-6714, broome-6725, kalgoorlie-6430