Last Updated:Friday - 09/24/2010
December 6, 2004
Cradle the dying in peace, love
If we are to be consistent and convincing in our opposition to assisted suicide and euthanasia, we must promote palliative care for the dying.
Federal Justice Minister Irwin Cotler has said he wants another national debate on allowing assisted suicide in Canada. But there would be no widespread desire for such measures, if Canada's hospitals were consistently doing a good job of caring for the dying. Such care would involve effective pain relief, human touch, spiritual counselling, an opportunity for personal relationships and an absence of invasive therapies designed to keep terminally ill patients alive at all costs, but do nothing for their quality of life. (See stories on Page 10.)
The Netherlands has only 74 palliative care beds in the entire country. This is a nation that has made its choice clear - when patients approach death they can choose assisted suicide or, if they won't, they will be killed through euthanasia.
Some people call this compassion; the better term is despair.
Edmonton, thanks to the pioneering work of Caritas Health Group, is showing that palliative care is the better way. Twelve years ago, 78 per cent of cancer deaths in the city occurred in acute care hospitals; by 2002, that had been reduced to 39 per cent. The development of palliative hospices, palliative home care and tertiary palliative care had made the difference.
In the Capital Health Region palliative care is a priority. More needs to be done, but the model of care for the dying is moving in the right direction.
This, unfortunately, is not universally true across Canada. Rural areas, in particular, suffer from a lack of local expertise in providing all aspects of palliative care even if the desire is there to allow the terminally ill a good death.
In Canada, according to medical reform advocate Dr. Michael Rachlis, about 70 per cent of deaths every year still occur in hospitals, down only slightly from the 75 per cent figure of the early 1990s. Even though they are in hospital, dying patients often do not receive adequate symptom control, especially control of pain.
Rachlis estimates that if the Edmonton model were implemented across Canada, it would free up 1,500 acute care hospital beds, almost as many as in the whole city of Winnipeg.
"All told, thousands of hospital beds are devoted to providing active, aggressive hospital care to patients who are ready to die. It's a double loss. Patients and their families usually don't get the symptom control and spiritual care to help make their last days comfortable and meaningful. The health care system also wastes resources that could be used to provide the end-of-life care that patients and families really want," Rachlis wrote in his recent book Prescription for Excellence.
The greatest obstacle to be overcome in our development of palliative care is the desire to control death. Too much of the medical establishment wants to resuscitate at all costs - to prevent death from taking its natural course. That leads to a reaction that is the polar opposite - to end pain and suffering by taking the patient's life.
Both approaches share the assumption that death can and ought to be controlled. Well, we have a duty to preserve life. But that duty is not absolute and its exercise must not be fanatical. There is also a duty to recognize when death is near and to drop our crazy interventions meant to hasten or postpone death.
Palliative care recognizes that death has its place in the human journey. We give death its rightful place when we try to make people comfortable in their dying days and give them the opportunity to come to peace with their Maker and with those people who mean the most to them.
More and better palliative care, not assisted suicide, is the proper goal of public policy for those who are dying.
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