Euthanasia and Aged Care

Carolyn Wallace is the director of clinical services at Southern Cross Care, Tasmanias leading aged care provider.

https://www.youtube.com/watch?v=o9VlQO7MK5c

Q: Why is the aged care sector such a large stakeholder in end of life care?

People only ever come to residential aged care when there is no other option left for their care. Usually its the last

place they live. At our Rosary Gardens facility, for instance, in the last 12 months the average length of stay for a

new resident is just under 60 days. So people really are coming at the end of their life for end of life care.

Q: Are there misconceptions about the dignity of living and dying in an aged care facility?

Thats partly because people know nothing about what aged care is, and so they assume, and a lot of the pro-

euthanasia information, puts across the impression that death is undignified unless its very deliberate when actually

that is not the case. Most Australian aged care facilities adopt whats a philosophy called a palliative approach to

care. Its not palliative care. What most people think of as palliative care is actually end of life or terminal care. But a

palliative approach to care embraces the W.H.O. definition of palliative care which affirm life, consider that death is

normal and that the role of palliative care and the palliative approach is to neither hasten nor postpone death. So a

palliative approach is built on that premise. Its an evidence-based approach and its aim is to improve peoples

quality of life throughand particular people with a life limiting illnessthrough early identification and assessment

of any issues and concerns, be they physical, health related, medical, cultural, spiritual, all aspects and it also adopts

a very open and positive attitude to death.The residents, even those with a significant cognitive impairment, know

that this is their last home. People chose to work in aged care because they feel that the aged have a value and the

experienced staff in aged care realize that one of their primary roles is to assist somebody to live the end of their life

with some dignity and with some value. As I said before a palliative approach neither hastens nor postpones death

but the staff pride themself that one of their main goals is to help people have a good death.

Q: Do the elderly have control over their end of life medical treatment?

Aged care is one of the areas of nursing where there is impeccable assessment over the whole gamut of the persons

needs, not just their physical needs. Any competent person in this state can decline any medical treatment option

that may be offered to them, at any stage. That includes things that may be quite simple such as an investigation.

Any competent person can decline to have that now, theres no need to have anything special or any special

legislation to make that happen, everyone has that right now. Any person, any adult, can also plan for what they

would like to have happen, when they are no longer able to do that for themself. Anybody can make an advanced

directive. In a person who is no longer competent, who hasnt made an advanced directive, we and their treating GP

would always speak to their families before embarking on a course of treatment such as something as simple as

antibiotics for a chest infection. At any time people have the right to say no, thats enough, or no, I dont want

that.

Q: If euthanasia or assisted suicide were introduced what type of pressure would the elderly experience in an

aged care environment?

Residential aged care is community living, and so people live in a community with people they didnt know before

they came here and there is a sense of community amongst them. So if Mrs Brown in room 10 decides, she and her

family decides, that she is going to euthanase herself, her family will talk to her friends, Jean and Shirley and Bill and

the other people with whom she has lived for some time and their families and that will set people thinking about

their self worth .and residents will think, well should I not, should I do that, and it may be something they have

never considered before. They may think that theyre a burden on their family; my daughter now has to travel 20

kilometers 3 times a week to visit me, thats an imposition on her, so perhaps if I took the same path as Mrs Brown

perhaps I could save my daughter that trouble. There are lots of financial implications for people, perhaps instead of

having that short holiday on the gold coast my son and daughter-in-law could now have a nice overseas holiday if

they could access my estate. A lot of these are unintended consequences of Mrs Brown euthanasing herself.

However, they are very real consequences, and so youve got people who are happy and happy that their quality of

life was what they would expect it to be at that stage of their life are now finding theyre questioning that value

and people are actually devaluing themselves and devaluing their contribution. I think the atmosphereits a very

cruel thing to do. It would be a very cruel atmosphere in the facility, it would very quickly become full of people who

think Im actually here, I probably shouldnt be here, I probably should have had the courage to euthanase myself

but I havent, therefore I am even less than those people who have chosen to do that.

Q: What type of pressure and abuse are the elderly already subject to?

There are two things that fall into the resident abuse category that you see every day in an aged care facility. One of

those is what I would term petty or minor financial abuse, where relatives regularly ask the elderly resident for

money. The other thing that you see regularly is people enforcing some social isolation on their family members by

limiting who can visit, by not helping family members who were significant to the resident who cant get themselves

there independently by always having some excuse why they cant come, and those people often only encourage

visitors who will follow a particular line of thought that the family wants, so if you had a family member who was

keen that mum went down the euthanasia paththose sorts of peopleand sometimes they dont realize that

theyre doing it, would discourage very actively visitors who might give mum a different perspective or encourage

mum to question this particular family members view. If you have that family member whose opinions inform the

rest of the familys and that person thought that mum should euthanase herself, very quickly that family member

will influence others

Q: Is there a need to introduce euthanasia or assisted suicide in view of the standard of end of life care in

Tasmania?

My personal view is I dont think the legislation is necessary at all. Any individual has the right now to decline or

refuse any treatment option that is offered to them. Palliative care services work very well in all but a very few

extreme cases and you shouldnt write legislation for the extreme cases, you should write it for the multitude as it

were.