Doctors and a ‘good death’

Former AMA Vice President Dr Chris Moy says a new AMA Position Statement reminds us that a patient’s doctor has a vital role in managing

As Benjamin Franklin once said, ‘In this world, nothing is certain except death and taxes’. But despite the inevitability of death, end-of-life care remains an messy afterthought in terms of focus and resourcing in health policy.

This may be due to a denial of our own mortality, but also because of the hand balling of responsibility and poor coordination of policy for a form of care that is multidisciplinary and primarily provided in the community. And while for many the introduction of voluntary assisted dying (VAD) across the country is a welcome change, VAD is of itself not the panacea that will bring a ‘good death’ for all; nor does it alone solve the woes of end-of-life care.

What is required is a recognition among politicians and decision-makers that end-of-life care requires a genuinely coordinated approach with adequate funding so patients (including each one of us one day), at a time when they are at their most vulnerable, see a true team providing seamless compassionate care to allow them to have a ‘good death’.

After a 12-month consultation that included state and territory AMA offices, the AMA has released its updated Position Statement on Issues Arising at the End-of-Life 2023. The statement covers a range of issues such as palliative care, advance care planning, access to services, groups with diverse needs, the cultural needs of Aboriginal and Torres Strait Islander peoples, children, decisionmaking capacity, health workforce and system development, grief and bereavement, carers and research.

As doctors, we have a duty to provide the care for a patient with a life-limiting illness that aims to alleviate pain and suffering, uphold the individual’s values and preferences for care, and allow them to achieve the best quality of life possible. As such, the Position Statement reinforces the importance of access for all patients and their families to timely, affordable, quality palliative care services, regardless of where they live in Australia.

Palliative Care Australia has identified a significant unmet need for palliative care and estimated the demand for palliative care in Australia to increase by 50% by 2035 and double by 2050, according to the Palliative Care Australia Roadmap 2022-27. To meet current and future demand, we must have appropriate, ongoing investment in palliative care

More South Australians access VAD permits

delivery at the national, state and territory levels, including in specialised services, general practice and residential aged care Facilities (RACFs), workforce development, research and data collection.

This investment must be accompanied by sufficient and adequate planning; funding; the training, coordination and clinical governance of health practitioners; and adequate health and related services to expand the trained palliative care workforce and break down the siloed approach to end-of-life care.

Investment in palliative care supports patients and their families and makes good economic sense. Palliative care services lift pressure from the health system through reduced use of health services (such as fewer hospital transfers and admissions, shorter hospital stays, and reduced use of intensive care units and EDs), better coordination of the health care system, and improved wellbeing for carers.

As the AMA, we must ensure palliative care is not simply the poor cousin in health funding but rather the core business of health.

SA Health released its second Voluntary Assisted Dying (VAD) Quarterly Report in August, highlighting the number of South Australians choosing VAD.

The report indicates that the program continues to receive positive feedback from participants and their families, specifically concerning the support and care provided to those applying for VAD permits. VAD was introduced in South Australia on 31 January 2023. The first quarterly report showed that 28 people had a permit issued by the Chief Executive of the Department for Health and Wellbeing (DHW) between 31 January and 30 April. Of the 28, 11 died with VAD medication and one died without taking the substance.

The second report revealed that between 1 May and 30 June (a shorter reporting period to bring the quarterly publications in line with standard reporting), 40 people received a VAD permit. Of these, 32 people who received a VAD permit, aged from their 20s to their 90s, had died at the time of the report’s release on 22 August. Five of these had degenerative neurological conditions, 19 had terminal cancer, three had respiratory failure and five ‘other conditions’. Five people died without using the medication available. Eight of the 32 were supported by medical practitioners and 19 people self-administered medication. Forty per cent died in regional South Australia.

The report notes there are 66 medical practitioners who have completed the mandatory training, among whom 17 are in regional South Australia, and another 46 registered or part-way through the training.