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TE's palliative nursing experience

As a palliative care nurse, I am asked to end a patient’s life about twice a year – about 40 people so far. I consider it a privilege that these people felt safe and comfortable enough to ask me this difficult question. I have never done so as I do not think it is my place, I do not have the right medications and it is not legal.

I have cried with people that it was not part of the holistic care I could provide. Sometimes I remember the faces and situations of those requesting assistance. You never quite forget the yearning in their eyes. They in turn have often comforted me that I could not do any better for them. I do believe people should have end-of-life choices, such as Voluntary Assisted Death. We can and must advance our response to this issue, through discussion, open debate and compassionate laws.

I have spent 16 of my 36 year nursing career in palliative care. This includes international, interstate, regional, metropolitan, community and inpatient settings. I have been privileged to work in gold-standard palliative care teams, so the requests to end patients’ lives were not related to gaps in service. Such gaps and lack of access do occur but that is not the issue at hand.

The truth is that even with the very best palliative care service in the world, there will be a certain percentage of patients who do not achieve a peaceful death.

I think 90 per cent of the time palliative care teams do a really good job of easing someone’s physical pain. But it is very hard to relieve somebody of emotional or spiritual pain. Their level of suffering depends partly on their tolerance for their quality of life. A growing number of people are seeking alternatives, which I believe should be legal and regulated. I have also nursed the failed suicide victims seeking some autonomy with a terminal illness. Many first responders have witnessed both successful and non-successful suicides.

In my career I have seen a lot of community education about pain control and palliative care, but there has been little debate about voluntary assisted death. Palliative care teams shy away from talking about it, but it is time for a transparent discussion. Many other countries have achieved good, well-regulated legislation.

I have seen doctors increasing pain medication to ease the end of life. I have seen terminal sedation, and I have seen people withdrawing from food and fluids. There have been hundreds of peaceful meaningful deaths. But there are still a number deaths that have stayed with me because they were not peaceful. For these people, the ability to make a choice about when to die, and to do it on their own terms, would have made a huge difference.

The best end of life care I ever saw was the vet who compassionately put down my beloved dog, with dignity and compassion. Just as we plan for birth, there should be options for death, with well-regulated legal avenues that protect the vulnerable.

Ms TE, March 2019

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