Pallative Care in New Zealand

From the author of THANK YOU, ELISABETH. A book relating the musings and journey of a Palliative Medicine Specialist.

“Thank you, Elisabeth” relates stories of people towards the end of life, that I have worked with over the years, as a palliative care/hospice doctor. These brave people have continued to teach me the vital importance of self-awareness and reflection when working with people who are suffering.

Palliative care aims to support people with life limiting disease as well as their families. The emphasis is on whole person care. It attempts to address the physical, emotional, intellectual and spiritual needs of the person, each within social context. The goal is to relieve suffering without artificially extending life when this is futile, and without deliberately shortening life.

Palliative/hospice care has existed in New Zealand for many decades with Palliative Medicine becoming a medical specialty in its own right in 2000. Sadly, however, access to excellent or even good palliative care and its funding has remained inequitable throughout New Zealand. But, it is certainly encouraging many energetic and enthusiastic clinicians have emerged, determined to change this state of affairs. I hope with the support of the public they are successful. Perhaps a critical mass has now been reached?

I moved into Palliative Medicine in the late 1980s after a career in Radiation Oncology. It was then I was fortunate to meet Dr. Elisabeth Kübler-Ross. She was the renowned expert on death and dying, who in the 1960s and 70’s started to really talk to and address the needs of the dying. This was at a time when death and dying were essentially taboo topics, certainly in Western culture. This diminutive, feisty, Swiss born woman practised as a psychiatrist in Chicago where she turned thinking about care of the dying on its head.

The workshop where I met Elisabeth was nothing like the usual medical didactic teaching. We were challenged to our core. I was introduced to the importance of being aware of my own emotional issues when working with people who are suffering.  Elisabeth seemed to be looking directly at me when she said “If you want to work with the dying, deal with your own shit first!” At first I didn’t have a clue what she meant but this gradually became clear and has continued to resonate during 30 years working in palliative medicine. In a nut shell; I learnt, with more self-awareness there is less likelihood of projecting my own issues into the situation and potentially adding to suffering. And, there is less likelihood of the my developing “compassion fatigue” or “burn-out”. I shall always be indebted to Elisabeth and her team for introducing me to these vital concepts. Concepts which not only help people to die more peacefully but also to live with more authenticity and joy.

I have worked in palliative medicine in many settings in New Zealand and Australia. These include, in hospitals and hospices as well as urban and rural community settings.

Alongside my work in palliative medicine, after training with Elisabeth’s organization, I was honoured to be asked to become part of her facilitating team for workshops in New Zealand and Australia. When her international organization came to an end, I was involved in continuing similar self-care workshops in this part of the world as well as Zimbabwe, several Asian countries, Samoa and USA.

The stories in the book are from many of these places and emphasise to me the universality of the human condition. The owners of the stories have continued to show me the importance of self-awareness and self-reflection. Self-awareness should not just be a ‘nice extra’ in clinical care but an ongoing clinical responsibility. We owe it to our patients and their families and we owe it to ourselves.

Thank You, Elisabeth by Sue Marsden, Mary Egan Publishing, RRP $30.00