Palliative Care, Case Study of New Zealand

This case study explores the palliative care services in New Zealand, focusing on pain relief, ethical considerations, and the quality of care provided. It highlights the importance of managing end-of-life conditions and supporting patients and their families. The study also discusses legal directives and ethical codes of conduct related to palliative care in New Zealand.

Running Head: PALLIATIVE CARE, CASE STUDY OF NEW ZEALAND 1
Palliative Care, Case Study of New Zealand
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Palliative Care, Case Study of New Zealand
No matter the person’s background, stability or who they are, there comes a time when
they eventually face death or an inevitable condition which leads to their death. When such times
come, managing the condition is very important because it extends the victims life. This service
is provided through palliative or the end of life care. Under palliative care, victims are provided
with dignified and humane services which prolong their lives as they approach their end days.
This care is very essential because it optimizes the victim’s quality of life before death by
looking into their physical, cultural, spiritual, and psychological requirements. It also supports
the victim’s family members and the caregivers as a preparation to embrace the situation
(Dempers & Gott, 2017). New Zealand has been ranked third best place to die in the whole
world, just behind Australia and the United States. The reflection was based on the level of
public awareness about death, availability of palliative care and the quality of care which is
available for people facing the end of life conditions.
Among the five aspects of Palliative care in New Zealand: providing pain relief and other
distressing symptoms, encouraging the victim that death is normal, hastening and postponing
death, integrating spiritual and psychological aspects of patient care and supporting the victims
to live enthusiastically until death; relieving pain and other troubling symptoms has proved to
contribute significantly towards the client quality of life and that of dying (Frey, Boyd, Foster,
Robinson & Gott, 2016).
Pain is among the common symptoms reported by palliative patients. According to the
International Association for the Study of Pain, the pain has been defined as the unpleasant
emotions and sensory experiences which are associated with the potential or actual tissue

PALLIATIVE CARE, CASE STUDY OF NEW ZEALAND 3
damage (Wilson, Oliver & Malpas, 2019). The pathophysiology of pain has remained a mystery,
and although it has helped classify pain as either neuropathic or nociceptive to guide its
management, the reality is that pain is a syndrome with nociceptive, psychosocial, neuropathic
and emotional overlays. The causes of pain are often multifactorial because they involve
diseases, their treatments, previous experiences and pre-existing morbidities (Lee, Ranse,
Silvester, Mehta & Van Haren, 2018).
For most of the palliative patients, the pain they undergo during their end days combined
with the distress when they realize that they are living their end days usually worsen their health
conditions. For parents, they are filled with worry and stress when they imagine living their
children as orphans. The pain undergone by these patients tends to deter the proper functioning
of their body immune systems (McLeod, 2016). Subsequently, when the pain is too high, it
makes it hard for the patients to fulfill the basic needs of their bodies like eating. Providing pain
relief and other distressing symptoms is therefore very important because it prevents the patients
from undergoing these conditions.
In New Zealand, there are a number of legal directives and ethical codes of conduct
which have been put in place to regulate and manage palliative care. Some of the key areas under
the two categories touch on planning the care, palliative sedation, cardiopulmonary resuscitation,
doctrine of double effect, assisted dying and withholding and withdrawing treatment (Oliver,
Wilson & Malpas, 2017). I would consider withholding and withdrawing treatment, assisted
dying and palliative sedation when advising health professionals who interact with palliative
patients and their families seeking options to manage the quality of dying.

PALLIATIVE CARE, CASE STUDY OF NEW ZEALAND 4
Basically, clinicians are entitled to difficult decisions when it comes to withdrawing or
withholding client treatment. Such decisions are however common when taking care of patients
who have just entered the terminal phases because there is no reversible cause of the
deterioration. At this phase, symptoms control and enhancing client comfort are paramount
which must be supported by all interventions available (Rollings, 2017). Interventions which are
not effective and don’t contribute to comfort must be ceased. However, before such decisions are
made, the relatives and caregivers must be thoroughly explained because they may end up
associating the death of their patient with the withdrawal in the future. Also, it makes relatives
and caregivers to feel that the clinicians are giving up on their patients.
The second consideration will be based on the assisted dying aspect. Assisted dying
embraces the concept of euthanasia and physician-assisted dying. In most cases, patients who
request assisted dying do so as a result of fear of what is likely to befall them (Sealy, Tuttle, Gent
& Fawcett, 2019). Others believe that they will not have control on their own care and hence
witness painful deaths. After being addressed systematically, such requests rarely persist. The
law in New Zealand is expected to allow the aspect of assisted dying. Supporters argue that the
change in the law will expand the choices on place and death timing; this will have to be
balanced to avoid the risks of shortcuts in coercion and care that would result from the change in
the law (Shahid, Taylor, Cheetham, Woods, Aoun & Thompson, 2018). This is because most
patients who feel burdensome will be vulnerable on the basis of the law. Finally, on the issue of
palliative sedation; if it is feasible will have to be discussed with the patients before being
undertaken as well as the relatives and the caregivers (Walker & Waterworth, 2017)

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References
Dempers, C., & Gott, M. (2017). The status of a public health approach to palliative care at New
Zealand hospices. Progress in Palliative Care, 25(2), 75-81.
Frey, R., Boyd, M., Foster, S., Robinson, J., & Gott, M. (2016). What's the diagnosis?
Organizational culture and palliative care delivery in residential aged care in New
Zealand. Health & social care in the community, 24(4), 450-462.
Lee, Y. Y., Ranse, K., Silvester, W., Mehta, A., & Van Haren, F. M. P. (2018). Attitudes and
self-reported end-of-life care of Australian and New Zealand intensive care doctors in the
context of organ donation after circulatory death. Anesthesia and intensive care, 46(5),
488-497.
McLeod, H. (2016). The need for palliative care in New Zealand. Technical report for the
Ministry of Health.
Oliver, P., Wilson, M., & Malpas, P. (2017). New Zealand doctors’ and nurses’ views on
legalising assisted dying in New Zealand. NZ Med J, 130(1456), 10-26.
Rollings, J. (2017). Palliative care: Nurses challenged to embrace new ideas. Kai Tiaki: Nursing
New Zealand, 23(10), 35-35.

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Sealy, T., Tuttle, J., Gent, S., & Fawcett, R. (2019). 89 Specialist palliative care CNS support
service for care homes in south tees–development and review.
Shahid, S., Taylor, E. V., Cheetham, S., Woods, J. A., Aoun, S. M., & Thompson, S. C. (2018).
Key features of palliative care service delivery to indigenous peoples in Australia, New
Zealand, Canada, and the United States: a comprehensive review. BMC palliative
care, 17(1), 72.
Walker, H., & Waterworth, S. (2017). New Zealand palliative care nurses experiences of
providing spiritual care to patients with a life-limiting illness. International journal of
palliative nursing, 23(1), 18-26.
Wilson, M., Oliver, P., & Malpas, P. (2019). Nurses’ views on legalizing assisted dying in New
Zealand: A cross-sectional study. International journal of nursing studies, 89, 116-124.