Palliative care is about minimising the pain and suffering for someone with a life-limiting illness. The goal is to give the best quality of life to people dealing with a terminal disease who face no prospect of recovering.
A life-limiting illness is also known as a ‘life-threatening’ or terminal condition. This could be cardiovascular disease, cancer, chronic respiratory diseases, motor neurone disease, AIDS, diabetes or Dementia. Palliative care is for people of any age who have received a life-threatening diagnosis, from children to adults and the elderly.
The main difference between end of life care and palliative care is that palliative care is provided to people who have been diagnosed with a terminal illness but may still have years of life ahead of them. End of life care seeks to minimise pain and suffering for people whose death is imminent.
It is about helping to treat, manage symptoms and offer support for people on their deathbed. End of life care is not limited to the hospital but can be offered in your own home, in a respite facility or a residential aged care facility.
End of life care can also include organising the practical elements surrounding someone’s death or incapacitation. It could involve discussing a medical or financial Power of Attorney, creating an advanced care directive dictating what medical treatments or decisions are appropriate or creating a Will.
Palliative care includes a wide range of services which aim to improve quality of life for the terminally ill. This includes:
Treatment of other physical symptoms including fatigue, nausea, breathing problems, skin irritation etc;
Social care ie. help with washing, dressing or eating;
Emotional and psychological support;
Support for family and friends.
Services can be provided through public or private hospitals, general practitioners, medical specialists like physiotherapists or occupational therapists, residential aged care providers and hospice services.
In palliative care sometimes medication used to reduce pain for a patient ends up causing their death or speeding up the process. This is known as the doctrine of double effect. Common law in Australia protects doctors from being found liable for these deaths if the medication was given for pain relief and the death was an unintended consequence. Other medical professionals like nurses or carers may be protected if they delivered the medication under a doctor’s orders. South Australia, Queensland, Western Australia and the Australian Capital Territory have specific legislation surrounding the doctrine of double effect.
The doctrine of double effect can be seen in a case study into the death of Sybil Zimmerman in 2014. The 84-year-old woman was given morphine by nurses at her aged care facility as part of her care. She lapsed into a coma and died three days later. An autopsy was performed and an inquest found the cause of death was the result of the woman’s pre-existing conditions: coronary artery thrombosis with cerebrovascular disease, dementia and pneumonia.
Palliative and end of life care are part of the big picture when it comes to death and planning for the worst. Defining what you want your final months to look like can make confronting death a little bit easier.
If you’re creating a medical Power of Attorney or an advanced care directive you can spell out exactly how you want to be looked after if you fall ill or become incapacitated. This gives you the freedom to dictate what medical treatment you would like, including any palliative care directives, before it becomes too difficult. You might like to leave instructions not to administer morphine or be moved into a retirement home. All of this makes up part of end of life planning.