Dying badly is a fact of life here in Canada

A few days after the Supreme Court of Canada overturned the prohibition against doctor-assisted suicide,

Harvey Chochinov

TROY MEDIA

A few days after the Supreme Court of Canada overturned the prohibition against doctor-assisted suicide, I received a note from a wonderful colleague of mine saying that her closest friend’s 53 year old son had just died of spinal cancer.

Two weeks before his death he had visited his general practitioner, experiencing “terrible pain.” Despite his anguish, his physician refused to give him morphine, claiming that because he was a smoker, he was, “More likely to become addicted.”

While this seems unfathomable, even grotesque, ignorance and lack of skill in attending to the needs of dying patients are still tragically common in Canada.

Despite the impressive strides that palliative care has taken – in areas such as pain and symptom management, and sensitivities to the psychosocial, existential and spiritual challenges facing dying patients and their families – at their time of licensure physicians have been taught less about pain management than those graduating from veterinary medicine.

Doctors are also not generally well trained to engage in end-of-life conversations, meaning that goals of care often remain unclear; and patients may not receive the care they want, nor the opportunity to live out their final days in the place they would want to die.

In light of the Supreme Court’s decision, these issues have never been more important, nor the need to resolve them ever more pressing.

The Court has given Parliament a year to sort out how it will move forward and rewrite the criminal code. Within these deliberations, it should be noted that the authority to provide a hastened death will be conferred on physicians, many of whom lack core competencies to care for patients nearing death.

To be clear, dying badly in Canada will rarely be the fallout of not having access to a lethal overdose or injection, and almost invariably, the result of inadequate or substandard end-of-life care.

With the clock ticking, the time for physicians to learn how to look after their patients until the very end, is now.

The Supreme Court felt that patients needed to be provided more choices. By adding doctor-assisted suicide into the mix, what options will dying patients in Canada actually have?

For 70 to 80% of Canadians, palliative care is not available and hence, not a real choice. A dear friend of mine recently died of brain cancer.

She spent her final months in hospice, where she received exquisite end-of-life care. She died comfortably, and in as much peace as can be found by someone having to leave this world far too soon.

In the future, how might this kind of scenario play itself out in the many Canadian settings that do not have adequate palliative care? There, the choices will come down to settling for sub-optimal care; dislocating from friends and family to seek out better care elsewhere; or, if one is so inclined, considering medically hastened death.

We are about to become a country that extends patients the right to a hastened death, but offers no legislative guarantees or assurances that they will be well looked after until they die.

As Canada deliberates its response to the Court’s decision, federal and provincial governments will need to make substantive investments in hospice and palliative care in order to offer patients and families choices that are equitable, compassionate and real.

While autonomy has driven the ‘right to die’ agenda, fear has been its engine. Now policy makers will need to grapple with how to draw a circle around autonomy, which means determining for whom and under what conditions medically hastened death will be permitted.

Establishing those boundaries has implications for who will feel more or less afraid, who will feel more or less valued and who will anticipate death with more or less sense of calm.

Of this we can be sure: the width of that circle and the stability of its diameter will profoundly influence the culture of caring for dying Canadians, and those amongst us who are most vulnerable, for generations to come.

Harvey Max Chochinov is an expert advisor with EvidenceNetwork.ca and a distinguished professor of psychiatry at the University of Manitoba. His column is distributed through Troy Media.

 

Just Posted

Blackfalds moves forward with seniors housing project

Public engagement meeting requests applications for plus-55 housing development

STARS launches 26th annual lottery worth over $4.5 million

Lottery raises money for new helicopters for Western Canada

Snowfall adds some delay to morning commute

The QE2 and area road conditions in central Alberta were partly snow covered

Reflecting on the impact of dementia in a loved one

January is Alzheimer Awareness Month

VIDEO: U.S. Congress to probe whether Trump told lawyer Cohen to lie

At issue is a BuzzFeed News report that about negotiations over a Moscow real estate project

Ponoka cowboy Vernon (Bud) Butterfield passes away

The Ponoka Stampede Association announced his passing Friday

Rare ‘super blood wolf moon’ takes to the skies this Sunday

Celestial event happens only three times this century

Ponoka RCMP are looking for a missing man

Police say he may be in Drayton Valley and they are worried for his wellbeing

Innisfail RCMP arrest two men attempting to sell stolen property

A large amount of music equipment and instruments had been stolen

Fashion Fridays: Inspirational gym outfits

Kim XO, helps to keep you looking good on Fashion Fridays on the Black Press Media Network

Company issues lifetime ban after man jumps from cruise ship

Nick Naydev posted the video last week showing him standing on the balcony of the Symphony of the Seas

Unruly passenger forces B.C.-bound flight to divert to Calgary

Police say charges are pending against a woman in her 40s

Pro-immigration rally planned for Red Deer on Saturday

Rally taking place outside Red Deer City Hall from 11 a.m. to 2 p.m.

Most Read