Palliative medication at the end of life: an honour and a right
A guest blog post by Kate Reed, Palliative Care Nurse Practitioner, Specialist Palliative and Supportive Care, Canberra Health Services
National Palliative Care Week (NPCW) from 22 – 28 May is Australia’s largest annual awareness-raising initiative to increase understanding of the many benefits of palliative care. This year’s theme, ‘It’s your right,’ aims to raise awareness about the rights of all Australians to access high-quality palliative care when and where they need it.
Palliative medications are a key component of good palliative care and can help to provide pain relief and control of palliative symptoms for people near or at end of life. Despite this, we know that some of these medications, such as morphine and sedatives, are being intentionally underused by nurses and health professionals in Australia, as the medications can sometimes be seen as having the unintentional effect of hastening a person’s death.
We do hear about these awful cases where pain relief is withheld or reduced at end of life because of fear that the nurse or health professional providing the medication might be hastening the death of a person. But these fears of legal or ethical risks are unfounded, as health professionals can be reassured that they are protected in all states and territories in Australia by the doctrine of double effect.
The doctrine of double effect means that if a person is providing pain and symptom management through the medications that they are prescribing or administering, and that they are doing that with the intention to relieve suffering and a patient dies, that they are protected in law. As part of the doctrine of double effect, this only applies when the person is close to death and when the goal is to relieve pain and suffering.
The doctrine of double effect does not just protect doctors, it protects everyone within the health professional team, whether they be the prescriber such as the general practitioner, or the specialist or the nurse practitioner, or they’re the person administering the medications.
If appropriate pain relief is not provided to a person, we are causing them harm, and we are also likely to be causing their family and carers harm in the bereavement phase. Withholding palliative medicines from a patient who needs them goes against the right that every person has to palliative care, and to die as comfortably and pain-free as possible.
I find that nurses and families get concerned, particularly when providing palliative care in the community, that they will be giving a medication and the person will die very soon afterwards, and they will say, “I think the last dose of morphine I gave killed them.” My answer to this is, “No, that's not what killed them. What killed them was their disease. What you did was allow them to be comfortable in end of life, because they were dying and that you were able to relieve their pain.”
Nurses and health professionals mustn’t be afraid to provide palliative medication for pain and symptom relief in patients at the end of life – providing that pain and symptom relief is not only a duty of care for us as health professionals, but it is an honour for us as well, to be able to ensure that a person can die without suffering and that their carers can go on, knowing that everything possible was done possible to address their loved ones’ distress.
Providing palliative medication to a person at the end of life when and where they need it to relieve their pain and symptoms is not only an example of good palliative care, but also a right for every individual, which is why it is supported by the law.
To hear more from Kate Reed and find out more about the doctrine of double effect, visit the Legal Protection for Administering Pain and Symptom Relief section of the ELDAC End of Life Law Toolkit.
Kate Reed, Palliative Care Nurse Practitioner, Specialist Palliative and Supportive Care, Canberra Health Services