Nurses’ unique perspectives on end-of-life choices must be heard

By February 2, 2018 Recent News

Nursing Review 1 February 2018
Family First Comment: An excellent commentary from a nurse and cancer survivor:
“surely our government can prevent undignified dying by increasing the palliative care resources.”
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The outcome of last year’s government inquiry into assisted dying left me both hopeful and disappointed that as a society we have not addressed alleviating suffering effectively.

The inquiry’s decision not to recommend law changes allowing legalised assisted dying was welcomed by Palliative Care Nurses New Zealand and Hospice NZ.

Though the concept of suffering is complex much can be said from lived experience. As someone who has been in remission from cancer for a number of years I actually chose to do nursing to help address this issue. Even though I’m hopeful and disappointed I continue to hope that my life can bring courage to others who are suffering.

I have witnessed in my career, the impact of non-physiological issues (e.g. family dynamics, financial, work etc) on individuals who were either dying or living with an irremediable or irreversible condition. I’ve seen these types of issues appear merely non-existent – before the diagnosis/prognosis – to almost devouring the person and their family near the end of the person’s life.

Unfortunately, these are the issues that continue to lack government remedy and have led to many vulnerable persons losing their dignity.

Some have said that suffering is a complex phenomenon that extends well beyond the biomedical model of care. I remember the pain, vomiting, and fatigue from the countless medical interventions I had when I had cancer.

Interestingly, what made me suffer were the broken promises made by close relatives, not being able to interact with my friends, and my classmates being able to write long coherent sentences while I struggled to write my own name. I had to reach the milestone of graduating from nursing school to come to the revelation of how helpless my family had felt and the financial stress they had encountered. Recollection of these events has never ended in a dry eye, especially for my mum (FYI: My mum will never cry in front of anyone – especially her children).

Palliative services running on ‘crumbs’
The topic of end-of-life care without fail brings up the “ineffectiveness” or “effectiveness” of our palliative and hospice Services. I would like to weigh in on this argument as a registered nurse who has seen for seven years the direct impact of resourcing on the delivery of patient services.

Our palliative services have been bandied around the media as being “world class” yet they suffer from the worst resourcing from our government. It astounds me that these scientifically-based professionals who lack resources are meant to deliver their world-class service to every person, every time to every area of Aotearoa with crumbs for sustenance.

In addition, I’ve also heard in debates that these same services are only a means of fulfilling the ethical/philosophical values of certain groups of society. Yet, this argument could be said about all the other specialties in healthcare. The philosophy of palliative care is “improves the quality of life of patients…[provides] relief of suffering by means of identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual1”.

If this indeed is their philosophy, anchored in evidence, then surely our government can prevent undignified dying by increasing the palliative care resources.