Drop the stigma about the end of life

Dr Amanda Landers discusses the stigma associated with palliative care and why the field deserves recognition 

Scalpels are a powerful tool in medicine, but words can be just as mighty. Some medical specialties are easy to comprehend - they cut, stitch, unblock, restart or fix. Others are just too hard to grasp. Palliative care is firmly in that camp for colleagues and the public alike. What does palliative care mean other than death? Mystery shrouds end of life, one of the most taboo topics in human existence. To the average New Zealander, palliative care equals morphine pumps and hospices, dying and death, the end and a passing.

Everyday those who work in this area of health strive to break the myths and legends surrounding palliative care. We endeavour to bring life, love and laughter to people and their families even when facing the darkest of times. As medical health professionals, we discuss symptoms and suggest medications but our work goes far beyond just the physical. We challenge people to see the value in what they can still do, we help people accept what is lost and embrace new realities. Palliative care is not a pill, it is an approach which can work for everyone to improve quality of life.

Palliative care does not work to change people’s lifestyles and we are not interested in criticising life choices. We offer knowledge about your condition, education about what to expect, assessment of needs and options about symptom management. Most palliative care services across the country offer a range of services such as biography, counselling, financial advice, functional assessments, family support, spiritual care and home visits. Health professionals may talk with patients and their family/whānau about what is important to them, where they want to be cared for when less well and what is the biggest obstacle to quality of life.

The specialty of Palliative Medicine has been in New Zealand over 20 years. We are a Chapter of the Royal Australasian College of Physicians and undertake three years of advanced training in communication, symptom management, grief/loss and holistic care. There are approximately 30 hospices throughout New Zealand with varying service delivery to rural areas. Not all regional hospitals in New Zealand have a palliative medicine specialist and most senior doctors would not have had any formal palliative care training in medical school.

In 2017, The Lancet published a position statement calling out to the global community to improve palliative care and pain management in every country. This included tertiary education providers such as the University of Otago. That same year, the Christchurch Medical School supported the commencement of a palliative and end of life care module teaching and exposing students to this specialty. Medical students reflect societal attitudes and the hope is that training in this area will improve, not only skills and knowledge of caring for people with life-limiting illness, but also attitudes to these patients. This is critical as we enter into an election year including a referendum deciding whether or not to legalise physician-assisted suicide.

Palliative care is about life until you die and promotes the idea that dying is a normal process. Most people in New Zealand die well, surrounded by family and friends. Even when the last breath is being taken there is potential to teach and inspire others. It is critical that our communities have conversations about dying and shed the fear we carry about this inevitable life event.

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