Opinion: The real conversation about death and why we need to have it

Categories: In The Media.

A deadline looms for the Canadian government to change our law on physician-assisted suicide. So it’s no surprise that this method of dying, with its deep, polarizing moral questions, is grabbing the headlines.

But few of us will choose it. What we need to talk about is how the vast majority of us will die. We’re all going to do this eventually, mostly from age-related causes such as heart and lung disease, cancers and/or dementia. About seven in 10 Canadians will die in hospitals and care homes, without access to the kind of care that would help us live longer and more comfortably than with medical intervention alone.

The crucial discussion we’re avoiding is about palliative care. Why is it so far off the public agenda, given it offers us a better way to die? Instead of marginal, often painful treatments, panic for ourselves, distress for our loved ones, and wasted costs to the health-care system, we could face death calmly and with dignity. Research tells us that nine out of 10 people can benefit from palliative care. But in our desperate bid to avoid death and guided with the idea that extreme medicalized efforts to keep us alive are considered “heroic”, many of us will leave this life in misery and suffering, our wishes about our deaths unexplored and unexpressed, while our families look on helplessly.

It’s unnecessary. Palliative care should be seen as essential for dying Canadians as pre-natal and obstetric care are for newborns. Research tells us how palliative care — which involves skilled communication with the dying person and their family about what to expect, advance care planning, as well as attention to pain, symptoms and the stress of serious illness — recognizes that life-saving measures rarely benefit those with life-limiting conditions. 

People receiving palliative care live longer than those who only get treatments for their diseases. It reduces hospital and emergency room visits, allows people to die where they choose and improves family satisfaction with end-of-life care. People receiving palliative care are more likely to find life worth living than patients who are not. Because they are spared severe pain, depression and family exhaustion, they spend a lot less time in hospitals, which is the most dangerous setting for frail older and seriously ill people. If terminally ill people had access to the services and approaches within palliative care earlier in their illnesses, for example, a year or so before they were expected to die, they would enjoy a much better quality of life before their eventual deaths. Some clinicians are beginning to understand this and are asking themselves, “Would I be surprised if this patient died in the next year?” to identify people who would benefit from palliative care.

American surgeon and writer Atal Gawande argues that sick and aged people are being sacrificed as “victims of our refusal to accept the inexorability of our life cycle.” While we are grateful for advances in medicine that mean longer, healthier lives, we need to turn our collective attention to the end game: in fact, three-quarters of Canadians are already there and are thinking about end-of-life experiences. How comforting it would be to know that when our longer lives are finally over, palliative care is the norm, not the exception it is today. Many palliative and hospice care programs limp along, with upwards of half of their costs supplied by donations, according to the Canadian Hospice Palliative Care Association. Significant disparities across Canada remain in terms of access to, the quality of, and the amount of personal money spent on end-of-life care. This, while most Canadians (73 per cent) say that provincial governments, which fund health programs, don’t give end-of-life care the high priority it merits. And in 2007, the federal government closed the End-of-Life Care Secretariat and stopped working on a national palliative and end-of-life care strategy.

It’s time to restart that public discussion. As a fallback strategy in the absence of good-quality, end-of-life care, medically assisted dying, while being an important choice for some people, reflects poorly on our grasp of the inevitable and on our collective compassion. ­

Kelli Stajduhar is a nursing professor and researcher at the University of Victoria’s Institute on Aging and Lifelong Health.

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