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Are we having enough conversations about palliative care?

Palliative Care Conversations

The burgeoning costs of our public health system is a subject of concern to many. Have you ever considered that a significant contributing factor to those costs is a reluctance by clinicians to have frank conversations with patients and their families about the limitations of certain treatments?

The Sydney Morning Herald has published an article of interest which suggests that patients, their families and the community at large would benefit from palliative specialists becoming more involved in patient care, and at an earlier stage than they often are. It is believed by some that a move in this direction would result in more patients passing away in their own homes (70% of patients prefer this to spending their final days in hospital) and prevent unnecessary pain and suffering caused by the implementation of treatments that will almost certainly result in no benefit to the patient.

The article quotes St Vincents Hospital palliative care director Associate Professor Richard Chye who suggests that a significant portion of treatments provided in public hospitals are futile. According to Dr Chye:

There are surgeons who do operations that all of us in palliative care know is a waste of time, and the reason for that is doctors don’t know how to say no … They’re scared to say no.

The implication is that many patients are being denied palliative options due to a reluctance on behalf of health care practitioners to be open about the futility and limitations of certain active treatment options.

Counterintuitively, the reluctance to have conversations about the likely ineffectiveness of some treatment options may in fact be shortening patients’ lives. The article states:

Research shows palliative care not only makes the last months of life more comfortable, it can also prolong life by reducing depression and anxiety and reduce costs by keeping patients out of hospital longer.

At Catherine Henry Lawyers we receive lots of inquiries about the failure, perceived or otherwise, of health practitioners to be open and honest and to provide sufficient information to patients with respect to their options. Often, such inquiries relate to failures to warn patients about the risks associated with certain procedures and treatments.

Doctors have a duty to provide sufficient information to patients. The extent and nature of the information required is dependent on the particular circumstances of each patient. When determining whether information provided to a patient is sufficient in the circumstances, Courts have regard to what is widely accepted as competent professional practice amongst practitioners practicing in the relevant field. Where a patient is suffering from a terminal condition, it is likely that the Courts would agree that there is an obligation to inform the patient of the terminal nature of the condition, the limitations of various treatment options and the fact the patient may choose to undergo palliative treatment as opposed to active treatment.

You can read more about Associate Professor Chye’s thoughts about the importance of palliative care in our health system and why he chose to specialise in in palliative medicine here.

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