A steady hand for the dying

Cate Swannell
Med J Aust
Published online: 29 October 2013

Professor Michael Ashby is the calm and steady hand on the shoulder of dying patients at Royal Hobart Hospital. It is necessary work that is both humbling and rewarding

Professor Michael Ashby occasionally wonders if he will be good at dying when his time comes.

“I can do the job I do calmly and professionally because it’s an abstract thing, there’s a sense of distance, because it’s not my own death”, he tells the MJA.

“One day it will be and in my quieter moments I sometimes wonder if I will be as good at it as I exhort others to be.”

Professor Ashby knows much about dying — he is the director of palliative care at Royal Hobart Hospital and is chair of the RHH’s Clinical Ethics Committee. He also holds a conjoint position as Professor of Palliative Care in the Faculty of Health Sciences at the University of Tasmania.

Professor Ashby trained at St Bartholomew’s in London under the mentorship of the famed Professor Gordon Hamilton Fairley — tragically killed by an IRA bomb that was meant for his next-door neighbour, conservative member of parliament Sir Hugh Fraser, in 1975.

That time exposed him to very young cancer sufferers, living constantly under the threat of death.

“I saw so many people who were not getting adequate pain and symptom control — the volume was enormous. That very much influenced me, in terms of my interests”, he says.

A stint at the Curie Institute in Paris followed, and then he took up a fellowship at the Peter McCallum Institute in Melbourne.

He is a past holder of joint clinical, academic and managerial positions at St Vincent’s Hospital and the University of Melbourne; McCulloch House, Monash Medical Centre, Southern Health and Monash University, Clayton, Victoria; and the Royal Adelaide Hospital and Mary Potter Hospice, Calvary Hospital, Adelaide. He is past president of the Australian and New Zealand Society for Palliative Medicine and past chairman of the chapter of Palliative Medicine at the Royal Australasian College of Physicians.

While Professor Ashby knows much about cancer, pain, palliative care, and dying, this does not stop him from being humbled by the process every time.

He is also passionate about teaching medical students the realities of the profession they are entering.

“Students are overwhelmingly interested in high-end acute care”, he says. “They want to make people better.

“That’s understandable, but it’s not going to happen half as often as they think it will, however good the technological progress is.

“They’re going to see pathways of increasing dependence, symptom burden, palliative care and difficult decisions — that’s the reality they’re going into.”

His message can be sobering — “I tell them they’ve made a conscious decision to live in the middle of human loss” — but Professor Ashby says it is worth it.

“As I come to the end of my second decade doing this, I sometimes think what a strange way to spend my life — always breaking bad news to people and living on an unmitigated diet of pain and suffering”, Professor Ashby says.

“But it’s necessary work and there are enormous rewards. People really do appreciate the guidance and advice I can give them. And there’s a tremendous amount of research work to be done.”

Perhaps it was the loss of his father in a car accident in France when he was just 11, or the early years of his career spent caring for young people suffering from cancer-associated pain and terminal illness in the wards of St Bart’s, that have made Professor Ashby so resilient.

“None of us are robots, the pain and suffering does affect us all. But there are mechanisms in place — supervision, regular breaks away from it”, he says.

“Ultimately you have to be self-aware and hope that your colleagues can point it out if you get weighed down by it.”

Unlike many of his colleagues in palliative care, Professor Ashby is a supporter of efforts to legalise voluntary euthanasia or assisted suicide, and has offered his support to those trying to get a private member’s bill through the Tasmanian parliament.

“I don’t see it as a dangerous initiative that needs to be seen off”, he says.

“Politically speaking, I am a ‘small l’ liberal, and I agree with [English philosopher] John Stuart Mill — an individual’s freedom should be encroached upon only when it is a danger to others.

“If you look at Holland and Belgium [where voluntary euthanasia is legal] the legislation is taken up by a small number of people — only 2%–3% of all deaths. So, I don’t buy the slippery slope argument that it will lead to people being killed off who don’t want to die”, he says.

“When death is done well, families grieve better.”

  • Cate Swannell



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