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The case for compassionate medicine

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By Ross Walker

With the recent vitriolic debate in the Victorian parliament and the repeat in New South Wales, I thought I would give my position on the topic of euthanasia.

There are many people who are concerned that once euthanasia is passed then vulnerable elderly people will be prematurely taken off the planet often at the behest of their greedy relatives looking to cash in early on the inheritance. The laws suggested around euthanasia will absolutely prevent this from happening.

But, I do not want to get into a debate about the particular nuances of these laws but would like to give my view on the place of euthanasia in medicine as it stands today. I have no doubt that there are some very rare cases where the only answer is euthanasia and if a person is suffering and their life is miserable, I have no problems whatsoever with assisted suicide.

But, it is my opinion that in most cases this is completely unnecessary and rather than supporting or promoting the practice of euthanasia, it is my opinion that doctors should be practising (which let me say many are doing so under the radar) what I call “compassionate medicine”.

As a doctor, I believe our first and most important responsibility is to relieve suffering. A good doctor relieves suffering, attempts to make an accurate diagnosis and form a reasonable and appropriate management plan for whatever condition the person suffers. I believe we should do everything we can to prolong someone’s life but do nothing to prolong their death.

Most sensible and well-trained doctors can clearly determine in conjunction with the person and their family, when the patient has entered the death phase. The death phase in my view is when a person has a terminal illness with absolutely no possibility of recovering.

This doesn’t just relate to terminal cancer but it also involves end stage Alzheimer’s disease, a severe stroke with a subsequent disability from which there is no reasonable chance of recovery, severe intractable pain for which no reasonable medical therapy is leading to any degree of relief and of course end stage neurologic conditions, such as motor neurone disease.

Without wishing to sound crude, I call this the “bum wiping rule”. If another person has to wipe your backside and there is no possibility that this will change and you consider the quality of your life to be miserable or you aren’t in a position to even discuss the issue, it is my view that all medical therapy should be stopped apart from pain relief and sedation. I would administer progressive doses of narcotics placing the sufferer in a peaceful oblivion allowing nature to take its course rapidly.

What we have now is many people languishing in institutions such as nursing homes at times for months to years, dying slowly in total misery. This is more the norm than the exception and in my view, society has gone mad to accept its dying citizens being treated in this fashion.

There are many people working in palliative care already practising compassionate medicine but often palliative care is not extended to those people languishing in nursing homes.

I’m not suggesting that compassionate medicine will be the answer for everyone but in my view, it is certainly the answer for most of us if we are placed in this situation. It is my view that we will markedly reduce suffering for many people if compassionate medicine becomes the norm not the exception.

Published: Friday, December 01, 2017


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