Dr. Regina McQuillan:

Regarding a trusted relationship, as somebody working in palliative care and medicine, whenever I meet a patient for the first time I do not tell him or her I work in palliative care. One cannot say this first because it will frighten people. I say to a patient that I have been asked to come to see them because I look after things like pain and symptoms. I try to open up a conversation to see what the patient's understanding of their illness is. Having a serious illness is quite a difficult and frightening thing to deal with. People are concerned about what is going to happen now and what is going to happen in the future. Their main requirement is to try to have some better understanding and reassurance from their family and healthcare team as to what we can do to help them. People are concerned about palliative care and afraid about medication. They are afraid that they may end up having to go to someplace that they do not want to go. They might want to die at home, for example. From a palliative care point of view, particularly with patients coming into the last months of life, we often discuss the changes they may be seeing in their bodies being related to an underlying illness and not necessarily being related to the medication they are taking. Sometimes people are reluctant to take medication because they feel the medication is causing the symptoms. Patients may feel that way and sometimes the family can as well.

We end up having many discussions with people about what is the best option for the person. Having the understanding that we are very clear about what it is we are doing is really important because so many people are fearful of different medications. If a person in palliative care for example, starts on a syringe driver they may think somebody is trying to kill them. I have those kinds of conversations on a regular basis with patients and their families. We have to try to counter the belief and the concerns people have. That is why I am concerned that any change in legislation allowing assisted dying will make it more difficult to be able to counter these beliefs.