Think of Palliative Care instead
The Star Nov 3, 2015
Dr Richard Lim Boon Leong, Consultant Palliative Medicine Physician
I WOULD like to respond to Pola Singh’s views expressed in “Mulling over assisted dying” (The Star, Oct 30).
I can certainly appreciate the suffering described in the case of his friend’s father and it really saddens me to hear how he was pleading for his pain and suffering to be stopped. However, rather than seeing this unfortunate case as a call to mull over doctor-assisted dying, I would appeal to people to ask two more pertinent questions: “Why was the pain and suffering NOT addressed by the numerous doctors who had been caring for him?”
“Why were there no discussions about his choices and preferences for care despite being told three years earlier that there was no hope of recovery?”
I would therefore like to urge Malaysians to be more aware of the field of palliative care, which is a specialised area of medicine that focuses on relieving distressing symptoms and improving quality of life for people with incurable and progressively fatal conditions.
Although palliative care has existed in Malaysia for over 20 years, there is still so much that is lacking in terms of expertise and available resources. We only have a handful of hospitals with specialised palliative care units.
Community palliative care services, which are mainly NGO-based, are only available within a limited area of coverage around major towns and cities. Pain-relieving medications like morphine are not readily available in all healthcare facilities.
So in the case of the writer’s friend’s father, was the problem an issue of not having the right to choose when to die, which resulted in unnecessary pain and suffering, or was it the lack of good palliative care? Isn’t it time we realise that more needs to be done to care for people with serious and incurable illnesses?
If there was enough physical, psychosocial and spiritual care to support people who are dying, would we even need to think of such an unethical act as assisted dying?
In a recent report published by The Economist Intelligence Unit titled The 2015 Quality of Death Index, various indices were analysed to rank the quality of palliative care for the dying in 80 countries across the world. Malaysia is ranked 38 out of the 80 countries, the top three being Britain, Australia and New Zealand respectively. It mentioned that there were only seven palliative care specialists in the country during the time of survey and that most medical schools in Malaysia did not teach palliative medicine as a compulsory component of their curriculum. Why is this so?
I believe it is because many people focus on the role of medicine as to cure and eradicate diseases. For this reason, even among healthcare professionals, they do not see value in an area like palliative care because, after all, the person is dying and once they have died where is the value? As a doctor practising palliative care for the past 17 years, let me tell you that there is indeed value in providing pain relief to a groaning patient even if it is for just one day. There is indeed value in providing support to distressed family members who are struggling to care for a loved one. And there is indeed value in helping a dying person to know that his or her life is still important and worthwhile right till their last breath.
So what can we do to improve this situation? Firstly, recognise that palliative care is something that involves all of us. Whether it is you or your loved ones, all of us in some way will encounter the need for palliative care. Secondly, educate yourself and your friends about some important things everyone should know about palliative care:
1. Pain relief is a human right and with the right medications it can be achieved 90% of the time.
Nobody should have to die in pain.
2. All healthcare professionals have a duty to comfort and relieve patients who are suffering. To say
“nothing more can be done” to a distressed patient is irresponsible and uncaring.
3. Make plans about how you want to be cared for in case you became terminally ill. Don’t wait till you
are sick to do this, and discuss it with those closest to you.
4. Allowing someone to die naturally is morally and ethically acceptable. Futile treatments may be
withdrawn or withheld and this is NOT assisted dying.
Finally, support the initiatives of hospice organisations in your vicinity either by making a donation or volunteering and if no such organisation exists in your area, consider getting more involved by starting one. The Malaysian Hospice Council will be holding a national congress on palliative care next April in Kuala Lumpur with the theme “Palliative Care is Everyone’s Business”, suggesting that everyone can play a role to ensure palliative care is available for all who need it.
To quote Mahatma Gandhi: “A nation’s greatness is measured by how it treats its weakest members.” Assisted dying is NOT the answer.