About Palliative Care

The Ministry of Health describes palliative care as:

Palliative and end of life care provides people with humane and dignified support and services as they face a life limiting condition. This care is essential.

  • Palliative care in New Zealand aims to:
    optimise an individual’s quality of life until death by addressing the person’s physical, psychosocial, spiritual and cultural needs
    support the individual’s family, whanau and other caregivers where needed into bereavement.

The Australian & New Zealand Society of Palliative Medicine (ANSPM) represents palliative care doctors. Find out more here.
Palliative Care Nurses New Zealand (PCCNZ) represents nurses who provide palliative care in hospices, hospitals and the community. Find out more here.

New Zealand ranked 3rd best in world for palliative care

New Zealand is the third best country in the world for palliative care, according to a report by The Economist Intelligence Unit.
The United Kingdom and Australia are ranked first and second respectively, and Ireland is fourth. The United States is ninth.The report considered data in five categories to decide an overall Quality of Death Index:

 

Find A Hospice

There are now 29 hospices throughout New Zealand. The first was Mary Potter Hospice, opened in Wellington in 1979, followed soon after by Te Omanga Hospice in Lower Hutt and Saint Joseph’s Mercy Hospice in Auckland.
In 2014 New Zealand hospices provided palliative care services for 16,041 people facing a life-limiting illness, and their families. Hospices are funded by the Government and community fundraising, and are generously supported by more than 11,000 volunteers.
Click here to find your nearest hospice.

WHO definition of Palliative Care

“Palliative care is an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.

Addressing suffering involves taking care of issues beyond physical symptoms. Palliative care uses a team approach to support patients and their caregivers. This includes addressing practical needs and providing bereavement counselling. It offers a support system to help patients live as actively as possible until death.”[1]

Palliative care is provided up until the end of life and is by definition never futile. Palliative care is never discontinued as it is provided up until the very moment of death (and even beyond with bereavement support for the family). So, whereas life-prolonging measures may be found to be futile, palliative care never is. The patient may reject palliative care interventions, but this does not mean that the palliative care approach is futile. Quite the contrary, palliative care is effective in relieving distressing pain and symptoms, and the care for patients – physical, psychosocial and spiritual – continues until death. Some have argued that the concept of palliative futility supports the need for euthanasia. This term, however, is a misnomer and a contradiction in terms, based on a false understanding of what palliative care is.[2]

 

Some Definitions:

Primary palliative careis provided for those affected by a life-limiting or life-threatening condition as an integral part of standard clinical practice by any health care professional. It refers to palliative care provided as a routine component of usual care by all individuals and organisations who are not part of a specialist palliative care team. Primary palliative care providers assess and refer people to specialist palliative care services when the needs of the person extend beyond the scope of the service.

Specialist palliative careis palliative care provided by those who have undergone specific training and/or accreditation in palliative care or palliative medicine, working in the context of an expert interdisciplinary team of palliative care health professionals.[3]

Non-treatment decisions(NTD): withholding or withdrawing medical treatment from a person either because of medical futility or at that person’s voluntary and competent request. NTD are not euthanasia … because NTD do not intend to hasten death, but rather accept death as a natural phenomenon through omission of ineffective, futile, very burdensome or unwanted life-prolonging procedures.[4]

Palliative Sedation: is the monitored use of medications intended to induce a state of decreased or absent awareness (unconsciousness) in order to relieve the burden of otherwise intractable suffering in a manner that is ethically acceptable to the patient, family and healthcare providers. It is an accepted, ethical practice when used in appropriate situations, and is considered to be an important and necessary therapy in the care of selected palliative care patients with otherwise refractory distress. Palliative sedation may offer an option for many conditions in which patients may request euthanasia or assisted suicide. Palliative sedation should never have the intention to shorten life.[5]

Who provides palliative care?

Palliative care is generally provided by a team, depending on the setting and the resources available. This team may include family members, community carers, doctors, nurses, psychologists and social workers.

Team members may include:

Understanding that there were shortcomings in the availability of palliative care, the Ministry of Health undertook a review of services in New Zealand in 2017. It was concerned that access to palliative care varied depending on diagnosis and prognosis, and the availability of services in each region, rather than being based on assessed need. There was evidence that some population groups were missing out on care appropriate to their needs and that there was room for improvement in the quality of care across all care settings.

Demographic changes also mean that the number of people needing palliative care is projected to increase significantly. Based on historic patterns of place of death, the need for palliative care is projected to increase between 2016 and 2038 by 37.5 percent in public hospitals, 84.2 percent in aged residential care and 51.8 percent under hospice care (including those under hospice services in aged residential care and in the community).[7]

The Ministry’s review identified five priority areas, with associated actions “aimed at achieving the overarching goal for adult palliative care service delivery in New Zealand. That is, services will provide high-quality care, in all settings and geographical locations, enabling someone to die in an environment that feels, and is, safe and comfortable”.[8]The priority areas included: the need to strengthen the emphasis on primary palliative care and on the knowledge and skills of the primary palliative care workforce, including allied health professionals; improving quality in all settings; growing the capability of informal carers; and responding to the voices of people with palliative care needs and their families and whānau.

It is often believed that if a person is terminally ill, they are faced with the ‘stark dilemma – either a gruesome death, strapped to machines, sickened by drugs, and stabbed with needles, or a peaceful death via a lethal prescription. Progress in symptom control, hospice, and palliative care belies this depiction of care at the end of life.’[9]

Not all people in New Zealand experience a good death but the ethical and caring response to this situation is to prioritise the availability of quality palliative care for all New Zealanders. What New Zealand requires at this point is a firm commitment to improve the availability of quality palliative care to all New Zealanders while also improving the general public’s understanding of palliative care.

[1]WHO. Palliative Care. 19 February 2018. http://www.who.int/news-room/fact-sheets/detail/palliative-care

[2]Radbruch, Lukas, et al. “Euthanasia and physician-assisted suicide: a white paper from the European Association for Palliative Care.” Palliative medicine 30.2 (2016): 104-116.

[3]Ministry of Health. 2017. Review of Adult Palliative Care Services in New Zealand. Wellington: Ministry of Health.

[4]Ibid., p.109.

[5]Ibid., pp. 109-111.

[6]Health Navigator New Zealand – Palliative Care Overview. https://www.healthnavigator.org.nz/health-a-z/p/palliative-care/palliative-care-overview/

[7]Ministry of Health. 2017. Ibid., p.8.

[8]Ministry of Health. 2017. Ibid., p.13.

[9]Sulmasy, D., Finlay, P., Fitzgerald, I., Foley, F., Payne, K., & Siegler, R. (2018). Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate. Journal of General Internal Medicine, 33(8), 1394-1399.