Palliative care: So many of us want to have a \'good death\'

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Palliative care: So many of us want to have a 'good death'

To submit a letter to The Age, email letters@theage.com.au. Please include your home address and telephone number.


Regarding Associate Professor Natasha Michael's article ("Palliative care work will endure", Comment, 23/5), whilst we would all strongly support the work of the Cabrini team (and medical staff everywhere who are devoted to the very difficult task of dealing with the dying), some of her views raise significant concern. Hopefully she has moved on from her formative experience as a naive, 25-year-old doctor dealing with the one great certainty in life – dying.

However, her struggle to match her commitment to palliative care with her new legislative responsibilities supports neither the wishes of at least some of her patients nor the majority of her community. There has been overwhelming public support for this socially progressive government's carefully researched, strongly controlled and carefully articulated "dying with dignity" legislation.

Far from "validating suicide", "accepting substandard medical care" and introducing "the intentional ending of life as acceptable medical treatment", the legislation opens the possibility of a careful appraisal of each patient's life and encourages a proper dialogue as to life's achievements and failings. It proposes the possibility of a "good death" and supports the best work of palliative care.

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Peter White, Mount Eliza

The choice between a tortuous or benevolent death

Natasha Michael cared for my mother and I have the utmost respect for her and her profession. The palliative care provided was exemplary and all staff tended to mum with gentle and respectful care. However, palliative care cannot address the suffering of every individual, as I can testify.

A vast majority of Australians agree that voluntary assisted dying should be provided as an option to patients whose pain and suffering cannot be adequately ameliorated at the end stage of life. It is not suicide, as suicide is the intentional taking of one's life when there is a choice between life and death. Those who request voluntary assisted dying are already dying and their choice is between a tortuous, prolonged death and a benevolent one.

Palliative care will always play a critical role in end of life care. Voluntary assisted dying should be considered as an integral, albeit very small, component of this care. It is not a failure of the "moral tradition" of medical care. Rather, it is a last-resort option to "cure" the pain that modern medicine is unable to do. It is a compassionate and humane option in end of life care.

Jane Morris, Malvern

Palliative care, our first choice of 'dying pathway'

I am disappointed by Natasha Michael's view that assisted dying threatens the practice of palliative care. Firstly, relatively few sufferers will pass the stringent restrictions on who may be given access to life-ending medication. But more importantly, palliative care must surely be everyone's first choice of dying pathway.

Who does not want to be kept calm, comfortable and pain-free until slipping away? Only when pain and existential suffering prevail does suicide become the choice – a choice we all deserve. It is wrong to set up a false conflict between these two medical movements, which should walk hand-in-hand. I am a strong supporter of both.

Anne Riddell, Mount Martha

Physicians must not put their private wishes first

Natasha Michael correctly positions palliative care as the first-line way to manage the suffering associated with dying. However, she sidesteps two important questions: what to do when the physician cannot alleviate suffering in a dying patient, and what to do when that patient requests assistance in dying to end such suffering. The tools of "eyes, ears, hands and a chair" do not make a dent in the pain from terminal bone cancer.

And if the physician denies a legal request for assisted dying in this case, then it becomes evident that his or her wishes have superseded those of the patient. Government-funded, Catholic-operated hospitals have signalled their intention to take this approach, imposing their (very tarnished) morality on their patients.

Janine Truter, The Basin

THE FORUM

Our right to decide

Palliative care is a wonderful thing and in many, perhaps most, cases it is the most appropriate option for the terminal patient. However, to suggest that there is no place for accelerated dying, no right to self-determination, is to deny us our right to make our own decisions as to how our lives should end.

Palliative care is successful in the majority of cases, but not all. No informed practitioner will claim 100per cent success rate and always there are those who will prefer to end their suffering on their own terms rather than endure the final agony of a protracted death. Denying us that opportunity is selfish, short-sighted and paternalistic.

Providing options is the least we should offer the dying, and these should not exclude alternatives which might be unpalatable to some people. Forcing someone to die slowly is not a compassionate alternative, and imposing our own views upon their decision-making process is unacceptable.

Bob Thomas, Blackburn South

The good old Aussie way

What's this? Japan's foreign minister has asked the English-speaking world to call its prime minister Abe Shinzo, not Shinzo Abe (World, 23/5). Not likely. Mate, this is Australia and, by crikey, we'll call people by whatever name we reckon.

Mark Morrison, Kew

What makes a 'real' man?

The National Community Attitudes towards Violence against Women Survey Youth Report has found high numbers of young Australians hold dangerous beliefs about sexual consent and controlling behaviour in relationships (The Age, 22/5). This mirrors the results of Jesuit Social Services' Man Box report last year. It asked 1000 men aged 18 to 30 about how a man should behave.

It found that 37per cent believed men had a right to know where their female partner was at all times and one in five believed men should use violence to get respect, if necessary. Controlling and aggressive attitudes like these are a significant risk factor for domestic and family violence.

Our report found negative outcomes among men "inside the man box" – eg, those who exercised control in relationships held rigid views regarding gender roles and believed a "real man" should have as many sexual partners as possible. They were over six times more likely to self-report perpetration of physical violence and sexual harassment of women. They also reported lower levels of wellbeing themselves, including poorer mental health, more frequent thoughts of suicide and greater likelihood of experiencing physical violence.

We need a renewed focus from governments, philanthropy, business and community groups to develop programs to support young men to understand and critique harmful stereotypes and beliefs. Failure to do so risks dangerous consequences for their partners, children and families.

Julie Edwards, Jesuit Social Services, Richmond

AFL's degrees of 'insults'

The AFL's counsel, Jeff Gleeson QC, told the tribunal there was "no graver insult or action to accuse an umpire of cheating". Well, based on tribunal penalties, I beg to differ. Carlton's Dale Thomas was fined $7500 on this charge. However, Sydney co-captain Dane Rampe was fined $10,000 with $5000 suspended for telling a field umpire that he sounded "like a little girl".

Paddy Lyons, Melbourne

To paraphrase ScoMo

So the balance of power in the Senate may mean the repeal of the "medevac" bill will be blocked. How good is the Senate?

Joel Oakley, Lower Templestowe

Towards a modern ALP

The leader is dead. Long live the leader. The unseemly rush by some Labor politicians to trumpet their leadership credentials exposed the myth of party unity. I would have been more impressed if the party had quickly closed ranks, supported the vanquished, dealt with the recriminations and moved on to a deeper analysis of the factors that led to its defeat. Then, decisions about who was best to lead a modern Labor Party in a rapidly changing and increasingly challenging political environment should have been carefully taken to avoid yet another term in opposition. Old style, committed Labor warriors should not assume they are the answer.

Gary Pollard, Mount Waverley

Seeking fresh leaders

No wonder the ALP lost. Once again the factions and unions are pulling the strings. The overwhelming proportion of the electorate are not union members and many do not trust them, especially the very militant ones. If the ALP does not want to spend another long period in opposition, it must present some fresh faces, not recycle the old losing ones.

Graham Carew, Briar Hill

Labor's winning formula

In 1969, the anti-Vietnam War movement was blamed by many as one reason (to some the main reason) for Labor failing to win, against expectation, after 19years of Liberal-Country Party rule. Over the next three years, that anti-war movement built up and became mainstream, led by a prominent ALP MP. And it became one of the things that swept Labor to power in 1972.

This is not the time for the ALP to retreat from a strong stance on the climate emergency. It needs to embrace it as the crucial point of difference, and develop and communicate a broad policy for rebuilding the economy, communities and job creation around renewables. It requires boldness for a non-conservative party to win from opposition.

Beth Spencer, Terrigal

Impossible ask for many

Eveline Clarke says, "To those who did not get their wish: We live in a democracy, get over it" (Letters, 22/5). How are the homeless to get over it? The people who are going under on Newstart? The families who are separated by pointless, cruel deportations? The people who are trapped in Manus and Nauru? Suicide? The Great Barrier Reef? How will the young "get over" living on a dying planet?

Penelope Buckley, Kew East

Protect our environment

Eveline Clarke, I am sorry but I will not "get over" the fact we have a dying Great Barrier Reef and inland river system, yet we have chosen to return a government that promotes coal and an environment minister who has no interest in the environment.

Leigh Fitzpatrick, Daylesford

Bipartisan, not left-right

Regardless of your views of Labor's policies on mining, housing or climate change, a day of reckoning is fast approaching.

No amount of spin will change the fact that we must rapidly develop new industries and jobs. An economy based on digging up fossil fuels and flipping houses to each other at inflated prices is not a sustainable path to prosperity. The changing global market will make sure of that.

Bipartisan recognition and support is the only way we will get out of the left-right quagmire we are now so firmly trapped in. The technology-dominated working future, which is hurtling towards us, will not care about our left-right leanings. Kicking the can down the road will also not make it go away.

Dr Roan Plotz, lecturer in environmental science, Victoria University

Revive Indigenous treaty

Election flim flam and so on it goes. (Yawn.) But so far, no mention for the kick-start and recognition of the treaty (thanks Hawkie, initially), for our Indigenous sisters and brothers. Who is brave enough to start the debate?

Maggie Browne, Kyneton

It's so easy in hindsight

There are so many incisive analyses by now clear-eyed pundits of Labor's election mistakes. Why were there scales on their eyes in previous weeks as the shrewd salesman, Scott Morrison, shepherded us along the narrow road to the deep north?

Frank Hurley, Alfredton

Explaining those polls

It has been interesting looking at how the polls "got the election wrong". My interpretation indicates that the actual figures were not that far from the election results, perhaps with the exception of Queensland where the discrepancies were significant.

However, no one seems to have discussed the possibility/probability of people not telling the truth when they were polled. We are exposed to polls incessantly.

I am sure that most people take little notice of the latest one, partly because it is no different from last week's poll, or the poll the week before or even five weeks before that. If someone contacts you and asks you to take part in one, it is possible that you are not interested, or you are annoyed at getting another useless phone call, or you have not made up your mind about who you will vote for. Or you may be mischievous and give a misleading answer.

Shaun Quinn, Yarrawonga

Premier, just build that link

Ross Hudson (Letters, 23/5) is wrong about the East West Link. I have travelled on the Doncaster Freeway for the past 20 years on a daily commute from Surrey Hills to Kensington. I constantly see the same vehicles, day in and day out, stuck in traffic. It takes me over an hour to complete the trip.

Daniel Andrews told us that it would cost nothing to cancel the contract but it cost more than a billion dollars in total. Now he has been offered $4billion in federal funding and he declares that it does not stack up. Obviously he has never spent two hours a day in traffic, on top of an eight-hour working day. Mr Andrews, how about working for all Victorians?

David Potter, Surrey Hills

Unfair attack on Andrews

Ongoing criticism of the Premier over the abandoned East West Link is misguided. His detractors need to be reminded that the former Napthine government signed up for the project with obscene haste, within weeks of a looming electoral wipe-out, and in full knowledge that Daniel Andrews was campaigning on a policy of tearing up the contract and that financial penalties would apply. Like the Christmas Island debacle, this is just another example of the Coalition playing political games with our money.

Peter Knight, St Arnaud

AND ANOTHER THING

Tony Abbott

Make him special envoy to Tuvalu so he can see the water rising to such levels that he can't live there. He'll have to seek asylum here.

Jenny Callaghan, Hawthorn

Envoy to the Vatican? Perfect. An irrelevant job for an irrelevant human.

Pete Cruttenden, Kyneton

He always was the Vatican's man in Canberra. Send him to his natural home.

Kath McKay, Upwey

Wouldn't he be too right-wing for the Pope?

Fred Gough, South Yarra

Politics

Albo vows to end class war. Does this mean the rich will go back to screwing over the poor with impunity?

Elizabeth Long, Collingwood

Is it possible to impeach the Prime Minister?

Perry Becker, Leopold

A worrying time – we've been Trumped.

Margaret Ward, Eltham

Aspirational: what's yours is mine and what's mine is my own.

John Kellett, Bundoora

I'm 74. I don't want to be seen as one of the "over 65s" who helped the regressives to a win.

Barry Hughes, Albion

For those who've come across the seas, offshore detention awaits.

Wendy Knight, Little River

The aspirational voter: "I'm poor, but if I vote Liberal I might be rich one day."

John Marks, Werribee

Labor erred when it ignored the rank and file and elected Shorten. Woe betide it if it ignores party members again.

Andrew Fawcett, Warrnambool

Shock. PM inherits budget black hole from previous government. Services slashed.

Ian Coles, Anglesea

Miracle man, kindly go back to the Bible. Those poor souls on Manus are also your neighbours.

Roger Christiansz, Wheelers Hill

Ask not what you can do for your country, but what it can do for you. And "they" did.

Brendan Hatherley, Hughesdale

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