Medicopolitical

No easy options when patients request to die


A panel discussion at the MOGA annual general meeting has highlighted a wide variety of views on physician-assisted suicide and the right to die.

Palliative medicine specialist Associate Professor Natasha Michael from Cabrini Health told the meeting that 70% of requests for deaths come from cancer patients so it was important medical oncologists understood the issues.

In the context of draft legislation being presented to the Victorian Parliament soon, she argued there was no need to change the law.

“We as a society do not regard suicide as something to be encouraged,” she said.

Associate Professor Michael said in her experience, expressions of the desire for death typically occurred at low points in a patient’s treatment.

However, poor social support, depression, anxiety and feelings of hopelessness were often more important than pain intensity or other physical factors.

She said it was an indictment of our society that we thought it was easier to end a life than to help patients find a way to increase the meaning in their lives.

“Investment in psychosocial care is important – but if you look at cancer care services in many areas, the presence of clinical psychologists is close to non-existent. We haven’t adequately resourced our services,” she told delegates.

“There are a very small proportion of doctors who are trained to explore existential distress and concerns yet patients and care givers need this assistance.”

Dr Justin Dwyer, medical director of psychosocial cancer care at St Vincent’s Hospital Melbourne, told the meeting up that up to 20% of cancer patients experience suicidal ideation.

He said epidemiological studies showed that patients with cancers such as pancreatic and lung cancer were at an up to 20 times increased risk of suicide – and especially soon after their diagnosis.

Dr Dwyer said there was an ‘implicit assumption that cancer itself was the main issue’ when cancer patients ended their own lives.

“Although we assume that cancer is a unitary stress, it is not,” he said.

He said it was impossible to prevent suicide in some people, even though many repeatedly told doctors of their intent and invited them to participate.

Science broadcaster Mr Robin Williams shared his experience of colorectal cancer and his concerns about living when many of life’s pleasures had gone.

He said his taste buds had gone, diminishing his enjoyment of good food, and numerous trips to the bathroom had ruined his enjoyment of uninterrupted sleep.

Sex, balance and energy were also affected but he was, fortunately, still engaged in his work.

“What happens if I am reduced so much that there is nothing left of me and I become someone else? I would like to have the option of something that goes on behind the scenes anyway.”

 

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