Conversations about the end

Range of views: Country Labor candidate for Port Macquarie Kristy Quill, The Greens’ candidate for Port Macquarie Drusi Megget, Dying with Dignity Victoria vice-president and retired urologist Dr Rodney Syme, The Nationals’ candidate for Oxley and Parliamentary Secretary for Regional and Rural Health Melinda Pavey, moderator and ABC Nightlife presenter Tony Delroy, Voluntary Euthanasia Party (NSW) lead upper house candidate Shayne Higson, Palliative care physician Dr Frank Brennan, The Greens’ Senator Richard Di Natale and MC and Dying with Dignity NSW president Dr Sarah Edelman at the forum.THERE aren’t enough conversations about end of life choice and the medically assisted dying debate, a 427-strong audience heard on Saturday.

A question and answer-style panel discussion at Port Macquarie Panthers brought together medical experts, politicians and candidates.

The audience heard the case for and against medically assisted dying.

MC and Dying with Dignity NSW president Dr Sarah Edelman said hopefully the forum was the start of a bigger conversation.

Dying with Dignity NSW aims to bring about legislative reform so terminally ill individuals who experience profound suffering can choose to die with dignity.

The Port Macquarie Group of Dying with Dignity NSW staged the forum which delved into issues from palliative care to education, advanced care directives, nursing home resources, education, current end of life choice, the push for legislative change and legal issues.

Palliative care physician Dr Frank Brennan said best practice palliative care was about having a broad combination of patient and family support through life limiting illness, not only addressing the physical aspects but the psychological and psycho-spiritual aspects.

Best practice palliative care also included meticulous symptom control, he said.

Voluntary Euthanasia Party (NSW) lead upper house candidate Shayne Higson said even the best palliative care could not alleviate all suffering.

Dying with Dignity Victoria vice-president and retired urologist Dr Rodney Syme said he was an unabashed advocate for palliative care. He would like to see a palliative care system where people could get all the benefits of palliative care but ultimately had control over the end of their life.

Dr Syme said he believed patients were the best judge of when pain was insufferable.

Meanwhile, Dr Brennan said the law allowed a competent patient to refuse treatment.

“If there is a sense that later on you wish to refuse treatment at a point when you’re not competent, you can make an advanced care plan,” he said.

An advanced care directive gives formal instruction on medical care if an individual is unable to communicate due to injury or illness.

Panellist and The Greens’ Senator Di Natale said it was important to recognise advanced care directives were only as effective as the communication and the system which supported them.

Senator Di Natale has introduced an exposure draft of a bill, which if supported, would give terminal patients around the country control over the manner and timing of their death.

Dr Rodney Syme:

AFTER over 25 years of counselling people about end of life concerns, the following ‘givens’, or self-evident truths have become apparent to me.

* That dying may be associated with intolerable suffering

* That such suffering may crescendo in the last days or weeks of life

* That some suffering may only be relieved by death

* The doctors have a duty to relieve suffering

* That doctors must respect patient autonomy

*That palliative care cannot relieve all pain and suffering

What then should a doctor do when treating a patient with intolerable and unrelievable suffering at the end of life, when person asks that doctor to hasten their death, in order to relieve that suffering?

This is a dilemma for the doctor, because, at least in theory, a doctor who deliberately hastens death, even by a short time, is guilty of murder.

In practice, the doctor can protect him or herself by arguing that their intention was to relieve suffering, not to hasten death.

The drugs used are strong analgesics like morphine and sedatives, the combination of which causes unconsciousness, depression of respiration, and if combined with a lack of hydration, will result in death. But this palliative process, to avoid accusations of intention to hasten death, must occur slowly, by accumulation of drug effects.

Moreover, it is difficult to prescribe morphine for people who do not have severe pain, and much of the suffering at the end of life is not simply physical pain.

Quite apart from people in the terminal phase of a terminal illness, there are a very large number of people who have an advanced stage of an incurable illness, such as motor neurone disease, Parkinson’s disease, all of which cause progressive neurological failure, and heart, respiratory, liver and kidney failure. These people may have intolerable and unrelievable suffering, but there is no effective palliation. Because their death is not clearly in sight, they may suffer for far longer than someone with a terminal illness.

It is not the nature of the illness, or the stage of an illness that underlies the problem, it is the presence of intolerable and unrelievable suffering.

As a society, should we demand that these people must go on with their suffering lives to the bitter end, commonly dying in a nursing home, hospital or hospice, the very place where the majority of Australians do not want to die?

Shouldn’t these people, if they are mentally competent to make their own decisions, and fully informed about the availability of every treatment or care, be able to make a request to their doctor for assistance to die, to have that request treated with respect, and acted upon by the doctor, with all due care, in a legal and humane manner? Ideally, that wouldinvolve providing the person with medication that they could take themselves, if and only if their suffering became unendurable.

They would have control of their own life and death, and that is what the vast majority of Australians want.

Most would not need it, but their great comfort is in having the choice.

Dr Frank Brennan:

THOSE who favour and those who disagree with a physician assisted death start at a common point – the simple acknowledgement of human suffering.

Let us start by looking at the existing care of suffering patients.

If the answer was ‘nothing exists’ then the situation would be shockingly stark.

Modern Palliative Care arose in response to this suffering and says to patients and families: we can and should do better.

Our skills and compassion must extend to the most vulnerable and those where there is no hope for survival.

To the public and to many health professionals there is probably no discipline so enshrouded in misconception. Palliative Care is the concerted effort to control pain and other symptoms, to support the patient and the family through this challenging and precious time and to allow death, when it comes, to be dignified and loving.

In terms of the debate about physician assisted death, therefore, our point of commencement is the same, but the destination is different.

People often worry that at the end of their lives, they will be kept alive unnecessarily. They worry that they will not be allowed to cease treatment and die.

In fact, that right to refuse or withdraw from treatment already lawfully exists. Doctors must listen when a patient says they have had enough. At this time palliative care can step in and say ‘enough’ and act as an advocate for the patient. Yes, modern medicine can do many things but we need to recognise a simple and incontrovertible truth – we are all mortal.

Another worry is the fear that doctors and nurses will abandon you when you are dying and that you will greatly suffer.

People worry that, at the very moment of their greatest vulnerability, health professionals will walk away.

This is the precise moment palliative care should and does get involved, dealing with these issues, addressing pain, nausea and other symptoms, making sure families and carers are supported, hearing the rhythms of fear and loneliness and despair and doing everything to make sure the death of the person is dignified.

Palliative care acts as a firm and clear voice in response to any health professional who says to an ill patient and their family “I am sorry, there is nothing more I can do”.

Palliative care says “No, there are many things we can do.”

We all commence with a genuine sense of the vulnerability and suffering of very ill people. Alongside the debate on the rights to assisted dying we should have a debate about the right to receive good Palliative care.

The fulfilment of that right would ease the concerns of many people.

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Tree change showcase comes up short

CONCERN over mining and coal seam gas in the Gloucester valley has taken some of the sheen off a planned two-day tree change showcase, organisers say.

Tree changers Bob and Sandy Tebbet.

The event, organised by tree changers Bob and Sandy Tebbet in collaboration with the Gloucester Uniting Church, was intended to encourage those living in the city and larger urban centres toconsider a rural lifestyle switch.

But Mr Tebbet said just four couples had so far decided to take up the offer.

“We put a fair bit of effort into promoting far and wide,” he said.

“The response has been disappointing. We really hoped to get between 15 and 20 couples to make it a really good show.

“There’s definitely been some hesitation. I’ve had a few couples interested that have been concerned over the uncertainty about mining and gas.”

Mr Tebbet said the showcase would continue as planned, albeit in a somewhat diminished capacity.

“We still plan to visit three properties all withdifferent rural pursuits,” he said.

“We’ll be looking at cattle, viticulture and country gardens.

“We’ll also be holding a lunch with the mayor and council general manager.”

A showcase dinner with guest speakers had been planned, but Mr Tebbet said it would now be a more intimate affair.

“We’re going to try and tag along with a couple of activities that are on – for instance Rotary is holding a wine tasting tour which will be a good opportunity to mix and mingle,” Mr Tebbet said.

Mr Tebbet said the response from Gloucester locals to the concept had been hugely encouraging with nothing but positive feedback.

“We were sort of hoping to give people the opportunity to experience a country environment,” he said.

“We were looking at it as an introduction of sorts. We wanted to show how things like building a house would be a different experience to what it is in Sydney or what would be involved in owning a horse or running cattle for instance.”

People interested in learning more about the showcase can contact Bob Tebbet at [email protected]苏州美甲美睫培训学校

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Moses ‘best’ at five-eighth “

Mitchell Moses. Picture: Anna Warr.WHEN Mitchell Moses burst onto the NRL scene with the Wests Tigers in July last year, so did the biblical references.

First he “parted the Red Sea”, now he “parts opposition defences”, “Moses leads the way . . . again” and “Holy Moses” headlines, fans and commentators proclaimed.

And while many believe he could be the club’s saviour, Moses himself, is yet to be convinced.

“I don’t know but I’ll give it my best shot to cement my spot,” he said.

“To be in first grade you can’t have one week off. You have to be consistent and play week in, week out.”

A hefty injury toll handed Moses his debut in round 17 last year but it was his performances that ensured hisplace in the side for the remainder of the season.

He was a standout in his first six games at the unfamiliar position of fullback.

Yet it was his shift to the halves in the last four games, and his combination with fellow schoolmate Luke Brooks that had many believing the club’s long-term halves crisis following Scott Prince’s departure in 2007 had been solved.

While happy to play any position, Moses believes he best serves the team in the halves.

“I want to cement my spot at six here, that’s where I play my best footy,” he said.

“I get my hands on the ball more there than I do when playing fullback.

“I’ve played a bit of footy with Luke in the juniors so I feel like we’ve got a pretty good combination there.”

One thing he is sure of though, is his place at the club.

“I have no intentions at all of leaving,” he said. “I love this club, they gave me my first shot.”

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Redlands to the rescue in Vanuatu

Cleveland Rotary will help Vanuatu man Denny, pictured with his youngest daughter Toumark. They lost their home in Cyclone Pam. PHOTO: Courtesy RotaryREDLAND residents, businesses, churches, clubs and schools are rallying to help people who have lost their homes after Cyclone Pam devastated Vanuatu last week.

The category 5 cyclone smashed through the South Pacific Ocean archipelago, 1750km east of northern Australia, leaving more than 70 per cent of the population homeless.

Redland businessman John Stynes, owner of Capalaba Complete Self Storage and Packaging Supplies, has property on Aore Island, in the country’s north.

He spoke with friends in Santo, one of the country’s largest islands,just after the cyclone and they said damage was mainly to trees and streets were strewn with debris.

Mr Stynes and his family left Vanuatu days before the cyclone.

“When we were there, most people thought it would be a category 3 cyclone and had no idea what was to come” he said.

“Nobody expected winds of up to 330km an hour or the demolition that occurred, as evident in Port Vila and surrounding islands – but our friends that have been able to be contacted are safe.”

Mr Stynes said many from Redlands owned property in Vanuatu and most were organising some form of aid.

“The people are lovely and friendly and mostly live a subsistence lifestyle so when their homes are gone, they really have nothing,” he said.

Capalaba Complete Self Storage and Packaging Supplies is collecting essential goods including tarpaulins, tinned food, hurricane lanterns, baby clothes, baby formulae, cleaning wares, sleeping bags, tents, torches, batteries, medical kits.

All items must be labelled and must be clean and packed in boxes or zip-carry bags, not in plastic shopping bags or rubbish bags.

The Rotary Club of Cleveland has committed to helping a family in the village of Pango, declared a disaster zone after most houses lost their roofs and many were destroyed.

A Rotary club assistant, based in Port Vila, visited Pango about 7km out of the capital, and met the family, headed by Denny, whose house was blown apart.

Denny and his family have no income or money to repair or replace their home.

The village football field remained flooded from the tidal surges and mosquitos were likely to cause health issues along with the lack of drinking water and food.

Rotary Cleveland is taking donations. Deposits can go to BSB 064 138; Account 00905716 Ref: Cyclone.

All money will go to the Rotary Australia World Community Service for Vanuatu. Those who need receipts should post a copy of the bank deposit transfer to P.O. Box 25 or email the club.


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Jobs boost for Bowmans

Bowmans Intermodal general manager Matt Williams, left, Member for Frome and Regional Development Minister Geoff Brock and board member Murray Smith at the funding announcement for the Mid North business.

Expansion of Australia’s largest inland regional port will create new jobs in the Mid North and greater efficiencies for the exports from South Australia.

An $840,000 regional development grant to Bowmans Intermodal will fast-track the duplication of the existing rail line at the Bowmans facility, inland from Port Wakefield, as part of a $3.8 million project to increase the capacity and value-adding activities of the site.

Regional Development Minister, Geoff Brock announced the grant from the enhanced $15 million Regional Development Fund while visiting the facility.

Fifteen full time equivalent jobs will be created by this expansion, as well as around 20 new jobs during the construction phase.

“The project will see the doubling of Bowmans Intermodal’s capacity from 25,000 Twenty Foot Equivalent Units (TEU) shipping containers per year to 50,000 TEU shipping containers through its road/rail operations,” Mr Brock said.

“The expansion supports the provision of better infrastructure facilities and services to the local mining and agriculture industries, in particular, through improved capacity and efficiencies.”

The project will expand the terminal to enable value-adding activities to take place on site, including the packing of export containers with mining products, and will increase the site’s capacity in general to handle greater train and container traffic.

Chairman of Bowmans Intermodal, Malcolm May, said the grant would see the rail duplication stage of the expansion completed in an accelerated timeframe.

“The Regional Development Fund grant means we will be able to carry out the extension earlier than expected,” he said.

“Expanding the existing rail line will give usthe capacity to marshal longer and more frequent trains through the terminal, generating greater efficiencies sooner for our customers and growing our business.

“We’ll see a reduction in regional freight costs realised through the increased terminal and rail line capacities, lowering supply chain costs and improving the competitiveness of industries supported through the facility.”

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