(9/14) Do We Need VAD When We Have Palliative Care?

Over the next few articles in this series I am going to consider some of the arguments against Voluntary Assisted Dying (VAD). In this one I am going to consider Palliative Care.

It is reasonable to ask whether we need VAD when we have a system of Palliative Care in place. Those who work in Palliative Care do great and valuable work, helping people at a most difficult time: their death or the death of a loved one. Unfortunately, Palliative Care is not equally available to everyone in the country.

Also, in opinion polls most people express a clear preference to die at home, but in fact most people die in hospital. VAD would in most cases allow individuals to die in the place of their choosing.

Palliative Care is not always effective

According to the Irish Association for Palliative Care (IAPC) in cases of ‘intractable physical and psychological distress’ — medical language for suffering that cannot be relieved by any means available to the care team — they use ‘deep sedation’. This means putting the individual into a deep coma and in most cases all treatment, food and water are withdrawn. Further details are hard to come by, but it appears that in most cases death follows in 24-48 hours. But it might take as long as ten days for the individual to die.

‘Deep sedation’ means that the individual is no longer present in any meaningful way. They cannot respond and will be unaware that their loved ones are visiting and that they care.

For the loved ones, it must be a painful experience to watch and wait with no flicker of response during this drawn-out death. In this series I have mentioned a ‘bad death’ frequently. ‘Deep sedation’ seems to me to be a ‘bad death’ in that the individual has no control over the circumstances of their death and the loved ones are left with painful memories.

A voluntary assisted death gives control of the circumstances and the individual is often able to respond right up to the moment of dying. (For an account of such a death see ‘A Beautiful Death: Her Choice’ by Corry de Jongh).

‘Assisted Dying’ has increased funding for Palliative Care

The IAPC has made two further arguments against VAD. First, it has argued that provision of VAD might mean reduced funding for palliative care. They two things are not in competition and there is no reason why funding for palliative care should be reduced. Recent evidence to a UK House of Commons Committee showed that all where VAD has been introduced, funding for palliative care has increased very significantly. And in Australia at least the quality of palliative care actually increased. This may be because there is a more rounded view of all the circumstances at the end of life. Most patients who receive VAD arere also receiving hospice or palliative care.

The IAPC’s second argument, is that VAD is against the principles of palliative care. Well, there may be more than one view about that. Palliative care workers could opt out of VAD on the grounds of conscience. However, in several countries, palliative care is integrated with all end-of life services including VAD. Evidently the palliative care staff there see no conflict in the roles. Compassion is common to both.

The Irish Hospice Foundation offer a range of support services for those who are bereaved and grieving.

Alan Tuffery is a member of End of Life Ireland. We are a voluntary group advocating for legislation to allow Voluntary Assisted Dying in Ireland. This is the ninth in a series of fourteen short articles on issues about voluntary assisted dying (VAD). The first article can be found here.