Richard Chye, director of palliative care at St Vincent, agrees that "there are problems with how Australians are dying" but argues that "for the majority, a palliative care experience is a good one".
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On Monday's Q&A, palliative physician Ralph McConaghy said that "perhaps 2 per cent" really can't be helped. This is no surprise. Palliative Care Australia acknowledges that "it cannot relieve all pain and suffering even with optimal care".
What is a surprise is that, knowing this, palliative care continues to turn away from the one answer that so many families who have watched – or who are currently watching – their loved ones die badly seek: the choice of assisted dying.
It's shocking. And it's happening because under current Palliative Care Australia guidelines, while it is ethically unacceptable for a patient to choose a death that is quick and painless, it is ethically acceptable for them to choose a slow, painful death by dehydration and starvation.
McConaghy said on Q&A that "there's always another tool in the toolkit", implying "don't worry, leave it to us". But that's only partly true. Of course there's another tool in their toolkit. The question is – why are they so reluctant to pick it up?
Because here's palliative care's little secret: More than 60 per cent of their services are provided by the church. This is not to question their compassion or professionalism. They do a mighty job. However, it is relevant because when it comes to helping people die, they are guided by an idea from the 13th century, namely Saint Thomas Aquinas' "Doctrine Of Double Effect".
It exists today as the central tenet of palliative care – "we will neither hasten nor prolong death" – and what it means is that, whatever you do to relieve a person's suffering, you must never intentionally hasten their death.
The problem with that is some dying people's suffering will only end with their death, because they are beyond meaningful treatment.
Why should rational adults, who are dying and who beg for help to die quickly, be told they have to die slowly instead? Who gave doctors all the rights and their patients none?
Read the comments on Chye's article and you'll see how angry people feel about their choices at the end of life being denied.
Yet Palliative Care Australia – like the leadership of the AMA, who also acknowledge that there is suffering that can't be relieved, but who oppose assisted dying – turn away from this. Their media strategy, mailed out to members before Monday's Q&A, urged them to support the line of "focussing the debate around death and dying in Australia – ensuring that everyone has access to high quality care as they face their final days".
Not a word about those people dying in pain and begging for help.
And there are others who weren't discussed on Q&A. People in nursing homes, hospitals, and our communities facing unbearable pain for which there is no relief, some of whom end their lives violently because they are offered no choice about how they can die.
Yet on these people, the leaders of our medical bodies are silent. "We cannot have an assisted dying law," they say, "the numbers are only small and the risks too great". Only the nurses – the ones who, tellingly, see this suffering close up – have listened: they say the law needs to change. The doctor's mantra is "do no harm". Shouldn't that also mean "do not look away from harm?"
