Cannabis in palliative care and the question of assisted death

The main focus of palliative care is to provide symptoms control, improve quality of life, minimise side effects of medications and provide holistic care, addressing many aspects of chronic, serious illness – physical, emotional, mental and spiritual. I strongly believe that cannabis has important applications in palliative care, controlling pain, nausea and vomiting while alleviating anxiety and depression. I feel that in this situation a bit of euphoria is quite appropriate.

Currently used medications don’t provide effective symptoms control, cause side effects and most importantly make patients feel like zombies unable to communicate with their loved ones. Here, I am going to share the story from one of the emails that I have received recently.

 

“My sister Sandra, was diagnosed with Multiple Myeloma in 2012. She was told at the outset that she had the ‘black’ variety which is resistant to the usual therapies. When she was diagnosed I researched and found that people were having a lot of success with keeping the Myeloma at bay using CBD. I talked to her many times about giving it a try, but she wouldn’t go outside of her haematologists treatment. I spoke to the haematologist myself about it and she basically said that it wasn’t a proven therapy and besides that, it wasn’t legal (she was cautious). I shared this research with another sister and Sandra’s sons. We were all of the opinion that it was worth a try but could not convince Sandra.

She had a stem cell transplant in 2013 and it seemed to be successful although the treatment itself nearly killed her. I nursed her through this period and what her poor little body suffered was cruel for her and for me. Watching someone you love suffer so much is one of the worst things I’ve had to endure.

Her resilience was amazing. She had lesions in her skull and her spine but was put on a course of iridium to strengthen the bones. She seemed to come good for about 3 years.

In September last year she had severe pains in her legs and in her stomach and was told that the Myeloma had come back and this time it was causing tumours. She was in so much pain she was on large doses of oxycontin and morphine shots every two hours. They gave her chemotherapy as well as radiation and she couldn’t eat due to the ulceration caused by the chemo to her digestive system – her tongue and her mouth. She weighed about 40 kg.

Her sons and I made the decision that we would give her medicinal marihuana and not tell her that we were giving it to her. At this stage we figured we would try anything, she was in so much pain. It was unbearable.

All I can say is that there was a miraculous change in her. My sister was very Christian so she attributed her sudden change to God. We sourced the crystal marihuana that was 50% CBD and 50% THC and we were giving her a small dose 3 times per day (the size of half a grain of rice). Not only was she pain free but she was also very happy. Her appetite came back. The doctors at the hospital kept quizzing me and asking if I was giving my sister cannabinoids and I always said no. They basically said that I could sign something (to alleviate them of any blame) if I was. I wasn’t prepared to do that.

Sandra was a singer and on New Year’s Eve, the doctors gave her a leave pass from the hospital so she could sing with my brother’s band. I have a lovely video of her that I now cherish. She was singing “Be my Baby” and dancing to the music, she was so happy!

The next day I was taking her to the toilet and she collapsed. She became a quadriplegic as the lesions in her spine finally cut through the cord.

I have always believed in euthanasia and I said to her “Sis, if this gets too much I can ask the doctors to increase the morphine and you can sleep more”  but she said “Why would I do that and miss out on all this lovely time with you?”. In that time, we laughed, we sang, we watched crap TV, she told me stories about all her boyfriends – she was a beautiful girl and had quite a lot of those. It got to a stage where she was refusing the oxycontin, she said she didn’t need it.

Finally, the disease took over and she died on Valentine Day. During those last few months she wasn’t anxious and she was pain free.

I firmly believe that if we hadn’t given my sister the marihuana I would never have had positive memories of those last few months. It was comforting to me to know that she wasn’t suffering and she wasn’t afraid of dying.”

 

This is such a beautiful story, sad but at the same time so full of love, care and compassion. I believe that patients should be entitled to medicine that helps them. These people and their families don’t need to feel like criminals, breaking the law.

Now, I am going to touch on the subject of euthanasia. It is concerning me very deeply. One hand I understand that people have the right to choose to terminate their life when disease is taking over and living becomes an agony. On the other hand, I feel that this situation is a reflection on our health system’s inability to offer effective symptoms control. The question begs asking, why people want to die. Apparently, one of the important reasons is the fear of becoming a burden to their family, loss of independence, loss of being in control, fear of becoming totally incapable both physically and mentally and fear of agonising, debilitating pain.

These people usually suffer from major depression, they are anxious and these mental conditions influence their decision as well. Life is simply not worth living anymore.
However, in this situation, when nothing is to lose and a lot of gain, why can’t we offer them good quality whole plant cannabis, good nutrition, supplements and spiritual counselling.

I believe that it would help these people to live their life till the end, feeling truly comfortable, being able to communicate with their loved ones and being guided to the other side with love and compassion. Somehow, it is more appealing to me than receiving synthetic drug lethal injection. As a doctor, I would be very uncomfortable playing the role of executioner.

I am expressing my personal view here. I understand, there will be many opposing opinions on the subject. I invite anyone to become a part of the debate.

2 replies on “Cannabis in palliative care and the question of assisted death

  • Lex Mclean

    Hi All,
    This is a story that i can relate to as my wife has Lewy Body Disease and is currently on Manufactures prescribed drug which are not working.. We have thru Dr Towpiik received Federal TGA Approval for Medicinal Cannabis and have applied twice to to NSW Health for Medicinal Cannabis and twice been rejected.by these non compassionate rightest group of experts. Last night my wife had a bad night and from 12.30 am i have had to help her out and back into bed 5 times as she had pains in her legs and feet and i had to walk her around the house and to the toilet. This morning when i was give her her 6 am pill she asked me if i could give her a pill that would make her die, i dont want to be here.
    Rgds lex

    Reply
  • Walter Irvine

    My late wife took her life February 20, 2015, after suffering 20 years with Myalgic Encephalomyelitis, a disease with chronic pain and fatigue. Had she been able to dose with Crystal Cannabis I’m certain that it would have given me more time with her and may have prevented a tragic death.

    She also wanted to die with doctor assisted euthanasia but her condition didn’t fit any of the profiles in any states where it was legal. Since she didn’t have a terminal illness diagnosis then she couldn’t get assistance from any doctors and any states.

    Reply

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