Page 997 - Week 03 - Thursday, 21 March 2019
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gravely ill? You might recover from it or you might not, but how do you want to be treated if you can’t communicate your wishes at a particular time?”
It is not always an end of life issue. Some people have catastrophic injuries and are for some time incapacitated and incompetent in decision-making, but they still recover; some of them recover and go on to live healthy and fulfilled lives. It is not always an end of life issue, but there are issues that we need to be better educated on.
The first 10 recommendations in this important report go to those issues of advance care directives and advance care plans. I am particularly pleased that the committee has taken its lead from the important work that was done by the Productivity Commission last year in relation to human services. The Productivity Commission made important recommendations in relation to advance care planning and palliative care. The committee has reflected how it sees that those recommendations are important.
It is not just the work of the ACT government in this space; it is the work of governments across the board to make things happen. One of the recommendations, for instance, is that we follow the Productivity Commission’s recommendations to establish a Medicare item number to encourage doctors and practice nurses to have more in-depth discussion about advance care planning. One of the things we heard, Madam Assistant Speaker, as you would know, is that these are difficult and often time-consuming conversations. They are not the sort of thing which a doctor can easily do in a 15-minute, short consultation. We think there would be more of an appetite to have this conversation if doctors were properly remunerated for it.
The thing that I am most pleased about with this report is the extensive recommendations in relation to palliative care. Palliative care is, in many ways, a new science. I think that in many ways it is misunderstood. I think that most people have the idea that you need palliative care if you are in the last stages of dying of cancer. That is a misunderstanding that we need to disabuse the community of. There are many people who have longstanding chronic and life-limiting diseases who would benefit from palliative care for many years before they meet their final end.
Part of the problem in the ACT and elsewhere—this is not just a problem in the ACT—is that we tend to take an acute medical approach to palliative care in the last few days or weeks of someone’s life. The general message that we received is that the sooner there is intervention of a palliative nature, the better. When we recognise that people are not going to recover from their disease—it might be years away or weeks away—the sooner you intervene, the sooner you can restore people’s equilibrium, reassure them and the like. It makes what remains of their life, generally speaking, better, more peaceful and more reconciled. It is certainly better for their families as well.
Of course, we have a great palliative care service here in the ACT, in Clare Holland House. There seem to be issues about whether patients can get into Clare Holland House soon enough and can stay for long enough. We have also noted that expansions to Clare Holland House have been funded through private philanthropy and the
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