By Dr Amanda Landers.

I get the feeling the general public think death is a black-and-white issue. I cannot think of a subject that has more grey.

I trained for 13 years to be a palliative medicine specialist. I attended Otago Medical School, completed advanced training in Australia and New Zealand and have been a specialist for 10 years.

Palliative care is multi-disciplinary to match the many dimensions of a person and their family/whanau. I have been dismayed at the attacks on our area of medicine in the media and on the health professionals who dedicate their lives to looking after these vulnerable New Zealanders.

In reading social media pages, I have realised there are many misconceptions that have taken root in our community which need weeding out. One of these misconceptions is that euthanasia and withdrawing medical intervention is one and the same.

I was asked to see a lady in her 80s with heart failure who lived in a rest home. She was asking her doctor to stop all her heart medication. The woman had discussed it with her daughter who was present and I could see she understood the decision may shorten her life, allowing nature to take its course. I agreed to her request and she thanked me profusely.

She said something that changed my practice immensely: “I would not be alive in any other century," she said. I realised this is true.

Withdrawing treatment is legally, ethically and morally her choice. But ultimately she will die of heart failure, not a lethal injection. This is the difference between a natural death and euthanasia.

I also constantly read about people dying in pain. Usually these are reported by the relatives for obvious reasons.

I am often asked to see a patient in the community because of their pain. I recently saw a woman with rectal cancer who experienced pain on sitting. Her partner told me that she was experiencing discomfort and a poor quality of life. When I spoke with the patient I asked her a general open-ended question about how she was doing. She made comments about fatigue, shortness of breath on walking, decreasing appetite and concerns over finances.

After half an hour I had to ask her about pain, since she hadn’t mentioned it, and I was able to make multiple suggestions to help. If I had only spoken with her partner I would have had a very different impression of her condition and would have missed the other issues that were more concerning to her.

There is a misconception that euthanasia and withdrawing medical intervention is the same thing.

Severe neurodegenerative disorders such as motor neuron disease have also been discussed in the media. There is a strong perception that these people have bad deaths. Evidence shows they do not choke or gasp at the end of life. In fact, I have never seen anyone choke to death. People do become sleepier because they have decreasing oxygen levels, but they are not aware of this. If they are aware that they are lacking oxygen we are legally and ethically allowed to use muscle relaxants in response to symptoms. In these cases a palliative care specialist is often needed to help support the local medical team.

And finally, I often hear the claim that people starve to death at the end of life. There is science to refute this as untrue. As a person becomes more unwell, their gut cannot digest food and fluids as it did previously. This is nature’s way of preparing the body for death. You can create unnecessary suffering, symptoms such as nausea and bloating, if you force food at this time of life.

Unfortunately this is not well understood by the general public or many health professionals, but it is a fact.

The answer to bad deaths is not euthanasia. The answer is a better understanding of basic medical ethics, of palliative medicine, of what happens to the body when it is dying, and how to care for  someone at the end of life.

Dr Amanda Landers is a community palliative care physician and a senior clinical lecturer at the University of Otago, Christchurch