Dr Cynthia Goh: "In Singapore, the government asked the hospices to take AIDS patients. However, much staff and public education would be needed to overcome tear and prejudice."
Ms Ellen Nightingale: "In Australia, most hospices will take AIDS patients."
Ms Joy Brann: "The WHO concept of palliative care includes any person suffering from a terminal illness with predictable outcome. The problem with stroke patients is that there is no clear predictable outcome."
Dr Catherine Krings: "We have to limit out admission criteria so that we have the resources to provide care. ..There is confusion between the mission of palliative care and the provision of palliative care services. Our mission is also to facilitate others to provide skilled palliative care."
Dr Rosalie Shaw: "Our mission is to provide appropriate holistic care to those with advanced progressive disease. Many would like to remove the words 'dying' and 'terminal' from the definition of our services. We also have to discuss the issue of euthanasia. Some people associate the term 'palliative care' with 'passive euthanasia'. Palliative care is not euthanasia because there is no intent to kill the patient. However, there are times when a patient will ask the palliative care doctor to end his life."
Dr Takeda: "We need to set limits. Patients need limits. We need to be able to tell our patients, 'I will do anything for you but I cannot kill you."'
Dr Maruya: "This is a codependency issue between doctors and patients."
Ms Nelly Fung: "Do doctors have a licence to kill? Is there value in the last part of life?"
Dr Devaraj: "The duty to care does not mean that one has a duty to kill. However, treating symptoms too aggressively can make patients ask for death because they feel that no one is listening to the fact that they want to be allowed to die."
Dr Maruya: "If a patient wants to be killed, this is a symptom which should be dealt with just as any other symptom should be dealt with."
It was decided that Mrs Nelly Fung, Dr Devaraj and Dr Co-Shi Chantal Chao would provide a statement on euthanasia for ratification by the Asia Pacific Hospice Network.
2 PALLIATIVE CARE EDUCATION
Dr Cynthia Goh: "In Singapore, in March 1996, a Post-Conference Workshop was attended by 100 participants from 20 countries who developed a palliative care curriculum for Asia. It was recognised that Asia has different curriculum needs in relation to death and dying rituals and in the interface between traditional and western medicine. Attitudes, skills and knowledge were addressed at this workshop. Participants also suggested which sections were relevant for different health professionals at various educational levels and for others such as teachers and the police."
Ms Ellen Nightingale: "This curriculum will be a valuable tool in the future. But we need a culturally sensitive workbook which palliative care teams can use now. This workbook could contain Suggestions for reading as well as case studies taken from the local context."
