Madam, - The recent death of your former columnist Nuala O'Faolain, following her public airing of her distress in an RTÉ radio interview with Marian Finucane, clearly struck a chord with many people.
Having worked as a palliative care professional for the past 12 years, I applaud her bravery and frankness in openly discussing such a sensitive and deeply personal issue. Although Nuala's anticipatory grief was presented in a very personal context, it must surely act as a reminder to us all that dying is a part of life.
While Nuala's interview with Marian Finucane was conducted in a very sensitive and professional manner, subsequent discussion of dying and euthanasia on Prime Timelast week raised many questions regarding RTÉ's journalistic balance and judgment. Unfortunately, there was no representative from hospice or palliative care on this programme.
During the discussion, Nell McCafferty, Nuala's former partner, said: "We already have euthanasia in this country; it is called hospice care." She also said: "The effect of the morphine will be to speed up your death."
If taken seriously, these statements could undermine not only the good work of caring professionals in the multidisciplinary hospice care teams, but more importantly the trust of patients and families in hospice care.
The cavalier dismissal of hospice care as merely a form of euthanasia is blatantly wrong. Euthanasia involves a process where there is a clear intention of terminating an individual's life, usually by lethal injection. This is anathema to those who subscribe to the principles of palliative care, as defined by the World Health Organisation. Giving morphine to relieve pain is part of the symptom-control function of hospice and palliative care. There is no evidence in the medical literature that the administration of morphine and its appropriate dose titration under proper professional guidance results in hastened death in hospice.
Furthermore, there is no evidence that the appropriate use of morphine or similar strong opioids in this setting results in even "slow" euthanasia. Dr Nigel Sykes, a consultant in palliative medicine at St Christopher's Hospice, has examined this issue in formal studies, and aptly concluded that "morphine kills the pain, not the patient" (see Lancet2007;369:1325-6).
For some patients in hospice care, symptom control may prove refractory to routine medications or interventions, and in such cases more sedating medication such as midazolam is necessary to reduce awareness of distressing end-of-life symptoms such as shortness of breath or hallucinatory activity.
Again, although the use of and dose of more sedating medications may vary from centre to centre, a study from St Christopher's Hospice suggested that such sedating procedures do not hasten death (see Lancet Oncol2003;4:312-8). The cause of death in these situations is progression of the underlying disease or consequent complications such as infection.
Neither the propagation of myths regarding euthanasia and hospice care nor the imbalanced media representation of end-of-life care should go unchallenged. Current and future patients of hospice care and families of those who received care in the past need to hear the facts, as opposed to wrongful, alarmist and opinionated pronouncements. — Yours, etc,
Dr PETER LAWLOR,
Our Lady's Hospice,
Harolds Cross,
Dublin 6.